Маркери ангіоґенезу та їх роль у прогнозуванні прееклампсії при багатоплідній вагітності

Abstract

Purpose - to identify changes in biochemical markers of endothelial dysfunction, preclinical manifestations of preeclampsia in pregnant women with multiple pregnancies after the use of assisted reproductive technologies. Materials and methods. A prospective study of pregnant women with dichorionic diamniotic twins after assisted reproductive technologies was conducted: 35 pregnant women with twins who were offered a developed monitoring algorithm (main (І) group) and 27 pregnant women who were monitored according to generally accepted methods of managing multiple pregnancies (control (ІІ) group). Statistical processing of the research results was carried out using standard programs “Microsoft Excel 5.0” and “Statistica 6.0”. Results. During the analysis of the main and control observation groups, an increase in the pro-angiogenic biomarker PlGF was noted up to 28 weeks (I group 604.9 (83.4-814.5) pg/ml vs. 568.6 (68.1-765.3) pg/ml in the II group). Іn the term of 26-28 weeks, in the main group, we noted a decrease in the level of PlGF below 100 pg/ml in 4 (11.4%) women, and in the II group in 6 (22.2%), however, clinical manifestations of preeclampsia, in patients, it was not noted. In the period of 32-34 weeks, the results of PlGF below the level of 100 pg/ml were obtained in 6 (17.1%) women of the I group against 7 (25.9%) of the women of the II group. In the group I we found 2 cases of moderate preeclampsia at 32 and 33 weeks of pregnancy. In the II group 4 cases of preeclampsia were identified. Two cases of moderate preeclampsia, which clinically manifested at 30 weeks. Conclusions. The anti-angiogenic factor, sFlt-1 and the pro-angiogenic factor PIGF, and their relationship are promising markers in the prediction and early diagnosis of preeclampsia in the multiple pregnancies after assisted reproductive technologies. Based on monitoring the growth dynamics of the sFlt-1/PIGF ratio, it is possible to predict the early development of preeclampsia even without clinical symptoms, and to make a decision about the possibility of extending the pregnancy or the need for urgent delivery. 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 interests was declared by the authors.