Алгоритм прогнозування невиношування вагітності в умовах природного йодного дефіциту

Abstract

The article presents a logistic model for prediction of miscarriage in the second trimester in conditions of iodine deficiency, which is based on the accounting of clinical and laboratory evidence, in particular, the altered parameters of iodine-thyroid homeostasis. The objective: development and practical application of the algorithm, which, based on the analysis of quantitative and qualitative parameters with high reliability, makes it possible to draw clinical conclusions and on their basis predict the risk of miscarriage in the second trimester of pregnancy. Materials and methods. We examined 80 pregnant women living in conditions of natural iodine deficiency (50 women with spontaneous abortion in the second trimester of pregnancy and 30 women with in-time deliveries). The parameters of iodine-thyroid homeostasis were assessed by iodine, free thyroxine and antibodies to thyreperoxidase levels. The algorithm is based on a pathometric recognition procedure with subsequent calculation of informative parameters, prognostic coefficients. Results. The result of the correct operation of the algorithm was a substantiated conclusion about the necessity for integrated accounting of the iodine-thyroid parameters in assessing the risk of miscarriage. It has also been established that the independent prognostic value of these indicators for a relatively high risk of miscarriage is realized only in conditions of the totality of their deviations and the level of iodine excretion < 49 μg/l. Accordingly, at an iodine excretion level >50 μg/l, corresponding to mild iodine deficiency, or lack of such (>100 μg/l), the independent prognostic value of hypothyroxinemia and high thyroid peroxidase antibodies level is not statistically significant. Conclusion. The presented logistic model allows to predict the risk of miscarriage in the second trimester with a high level of sensitivity and specificity. The high prognostic significance of the deviations of iodine-thyroid parameters, which is realized fully in the conditions of middle-severe iodine deficiency, is shown. Key words: logistic model for prediction of miscarriage, iodine deficiency.