CONCENTRATIONS OF D-DIMER, FOLIC ACID AND HOMOCYSTEIN IN PREGNANT WOMEN WITH POST-COVID SYNDROME

Abstract

Introduction. The problem of decreasing birth rate is becoming the main medical and social problem of modern Ukraine. Therefore, the preservation of each pregnancy is the main task of obstetrics. The outbreak of a global pandemic caused by the SARS-CoV-2 virus, war, population migration abroad and within the country have created unprecedented medical and economic problems. The aim of the study was to investigate the relationship between D-dimer, folic acid (vitamin B9) and homocysteine levels and major pregnancy complications in the third trimester in pregnant women with post- COVID syndrome.Material and methods. 60 pregnant women (the main group) with SARS-CoV-2, positive Ig A, M or G to SARS-CoV-2 participatedin the study. The control group consisted of 25 women with normal pregnancies. The test system used for the determination of folic acid was from Monobind Inc. (USA) and Axis- Shield Diagnostics LTD (UK) for homocysteine. D-dimer studies were performed on a Coag Chrom 3003 analyzer. Statistical analysis of the study results was performed using the Statistica.10 program package for Windows. The study was approved by the Ethics Committee of the Ternopil National Medical University named after I. Ya. Gorbachevskii (protocol No. 61 dated November 13, 2020).Quantitative results for normally distributed data are presented as arithmetic mean (M) ± root mean square deviation (m). Results of qualitative measurements were presented as number (n) and percentage (%). Statistical analysis of the research results was performed using the Statistica.10 statistical package for Windows.The study was conducted within the framework of the National Development Program “Improvement of Diagnosis and Treatment of Pregnant Women with Burdened Somatic History” of the Department of Obstetrics and Gynecology, Faculty of Postgraduate Education, Ternopil State Medical University named after I. Ya. Gorbachevsky (state registration number N 0121U100153, performance period 2021-2023).Results. According to our research, patients of both groups did not diff er from each other in terms of age, body mass index (BMI), erythrocyte and hemoglobin levels (p>0.05). Among the pregnant women in the main group, 25 pregnant women (41.7%) had a mild form of coronavirus disease, 14 (23.3%) pregnant women had pneumonia and were hospitalized, and 21 (35.0%) pregnant women had pneumonia and required oxygen support. The SARS-CoV-2 virus upsets the coagulation homeostasis system of pregnant women. The average value of D-dimer in healthy pregnant women was 0.56±0.16 μgFEO/ml, while in the main group this indicator was 16.48±4.25 μgFEO/ml (р<0.001). In our study, the folate level in the control group was 5.88±0.08 μg/L, while in the main group this indicator signifi cantly decreased and was 2.56±0.09 μg/l (р<0.05), compared with indicators in women with a physiological pregnancy, which can be considered a risk factor for the development of complications during pregnancy against the background of post- COVID syndrome. The average level of homocysteine in the control group was 7.8±2.28 μmol/l. The SARS-CoV-2 virus had a negative eff ect on homocysteine metabolism and caused moderate hyperhomocysteinemia (47.8±4.36 μmol/l, р<0.05) in pregnant women in the 3rd trimester.Conclusions. Therefore, SARS-CoV-2 virus during pregnancy has a negative eff ect on the course of pregnancy and upsets thecoagulation system of homeostasis. Hyperhomocysteinemia and a decrease in folate levels can be considered a promising marker for assessing the risk of complications during pregnancy against the background of post- COVID syndrome.