CHANGES OF THE SLEEP, HORMONAL BALANCE AND PROFILE OF CYTOKINES IN PREGNANT WOMEN WITH PLACENTAL INSUFFICIENCY

Abstract

Objective – to establish the correlation between the placental insufficiency, sleep disorders and pro- and anti-inflammatory part of the immune system by questioning, studying of the levels of melatonin, placental hormones and pro- and anti-inflammatory cytokines in pregnant women with placental insufficiency.Materials and methods. 80 pregnant women with placental insufficiency, manifesting as intrauterine fetal growth restriction (IUGR) of II-III degree in the 3rd pregnancy trimester (study group) and 30 women with normal clinical flow of pregnancy (control group) were questioned. 46 patients from study group and 20 patients from control group women were examined further: the studying of the blood plasma concentrations of melatonin, placental hormones (placental lactogen, free estriol), pro-inflammatory cytokines, such as tumor necrotizing factor-α (TNF-α), interleukin-1-β (IL-1-β), interleukin-6 (IL-6), and anti-inflammatory cytokines, such as interleukin-4 (IL-4) and interleukin-10 (IL-10), was conducted.Results and the discussion. Questioning showed that pregnant women with placental insufficiency (PI) in 86% cases experience the sleep disorders starting from pregnancy term 12-22 weeks (healthy pregnant women – mostly after 30 weeks, 57% cases), more commonly wake up 2 or more times per night (71% of positive answers, in control group – 23%), and 3 or more times per week (78% of positive answers, in control group – 17%). It also has been established that concentration of melatonin significantly decreases, if the pregnancy is complicated by intrauterine fetal growth restriction (study group – 126,87±14,87 pg/ml, control group – 231,25±21,56 pg/ml, p<0,001). The levels of pro-inflammatory cytokines in the study group were significantly higher, comparing with the control group (TNF-α: study group – 10,05±1,35 pg/ml, control group – 5,60±1,50 pg/ml, p<0,05; IL-1-β: study group – 14,67±2,13 pg/ml, control group – 3,96±0,92 pg/ml, p<0,001; IL-6: study group – 6,91±0,99 pg/ml, control group – 2,69±0,99 pg/ml, p<0,05). The same is true about anti-inflammatory cytokines (IL-4: study group – 5,97±0,50 pg/ml, control group – 3,74±0,62 pg/ml, p<0,05; IL-10: study group – 11,40±1,50 pg/ml, control group – 4,70±3,20 pg/ml, p<0,001). We did not find significant difference in hormonal concentrations between groups.Conclusions. Sleep disorders in pregnant women with placental insufficiency appear earlier and seem to be more expressed then in healthy pregnant women. The blood level of melatonin significantly decreases in case of placental insufficiency, manifested as intrauterine fetal growth restriction. The strengthening of the pro-inflammatory immunity, shown as the increasing of the levels of TNF-α, IL-1-β and IL-6, is also present in case of IUGR. The rising of the plasma concentration of the anti-inflammatory cytokines, such as IL-4 and IL-10, in our opinion, can be explained by activation of the mechanisms of compensation, which decrease the risk of premature labor.