Зміни в системах: обміну ліпідів та вуглеводів у вагітних із різними формами безплідності в анамнезі

Abstract

The most significant changes in lipid and carbohydrate exchange systems were in women with a history of endocrine and combined infertility, which is explained by their presence of risk factors, namely age, PCOS, an increased frequency of somatic pathology (metabolic syndrome, obesity, insulin resistance) complicated by the course of pregnancy. Purpose — to study changes in systems: lipid and carbohydrate metabolism in pregnant women with various forms of infertility. Materials and methods. Changes in systems were studied: lipid and carbohydrate metabolism in 127 pregnant women with various types of infertility. The distribution of pregnant women to groups is based on infertility factor: group I — 35 pregnant women with a history of endocrine infertility, group II — 37 pregnant women with a history of infertility of trumpe-peritoneal genesis, group III — 30 pregnant women with a history of combined infertility: trumpe-peritoneal genesis with endocrine, control group (IV) — 25 healthy pregnant women who did not have a history of infertility. To assess metabolic disorders, all women were measured for BP, blood levels were determined: glucose and HOMA (Homeostasis Model Assesment) index, triglycerides and high3density lipoproteins. Used: immunochemiluminescent, enzymatic colorimetric and kinetic enzymatic method. The validity for relative values was evaluated by the Fisher angular transform method. Results. Examining plasma glucose measurement data in women with different types of infertility by groups in the I and III trimesters found that in the I group, increased rates were in 5 (14.3%) patients in the I trimester and in 9 (25.7%) in the III trimester; in group III, 3 (10%) patients in the I trimester and 10 (33.3%) in the III trimester; while elevated blood sugar levels in group II women were in 3 (10%) patients in the I trimester and 10 (33.3%) in the III trimester, and in group IV none had elevated glucose levels in the I trimester and in 1 (8%) patient it increased in the III trimester. Determining the HOMA index in women with different types of infertility by groups in the I and III trimesters found that in the I group, increased rates were in 4 (11.4%) patients in the I trimester and in 5 (14.3%) in the III trimester; in group III in 3 (10%) patients in the I trimester and in 4 (13.3%) in the III trimester; while the indicator of the HOMA index in group II women did not change, both in the I trimester and III trimester and amounted to — 1 (2.7%), and in group IV no one had an increased HOMA index, both in the I trimester and III trimester. Analyzing high3density lipoprotein (HDL) measurement data in women with different types of infertility by groups in the I and III trimesters, it turned out that in the I group, 2 (5.7%) patients in the I trimester and 4 (11.4%) in the III trimester had increased rates; in group III in 3 (10.0%) patients in the I trimester and in 6 (20.0%) in the III trimester; while the HDL in women of group II did not change, both in the I trimester and in the III trimester and amounted to — 1 (2.7%), and in group IV no one had elevated HDL, both in the I trimester and in the III trimester. Conclusions. In pregnant women with a history of endocrine and combined infertility already in the first trimester, the glucose level exceeded 5.6 mmol/l in 14.3% and 10% of patients; in the III trimester, this indicator was equal to 25.7% and 33.3%, respectively. The HOMA index in the III trimester in these women was increased and was calculated in pregnant women with endocrine infertility in the past — 14.3% and in pregnant women with combined infertility — 13.3%, which was significantly higher than the indicators of patients who had tube-peritoneal infertility — 2.7%. In healthy pregnant women who did not have a history aggravated by infertility, there was no increase in the HOMA index. In pregnant women with a history of endocrine and connected infertility, the level of lipoproteins also increased by 11.4% and 20%, respectively, and triglycerides in 8.6% and 16.7% of women in the III trimester relative to pregnant women who had a history of tube-peritoneal infertility and healthy pregnant women. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: lipid and carbohydrate exchange, history of endocrine and tube3peritoneal infertility, pregnancy.