Development Of Pregnancy Complications Research Articles

Placental function and fetal weight are associated with maternal hemodynamic indices in uncomplicated pregnancies at 35–37 weeks of gestation

Over the years, there has been an increasing interest in the assessment of maternal hemodynamic responses during pregnancy. With the use of both noninvasive devices and/or maternal echocardiography, it has been shown that mothers who have pregnancy complications have altered hemodynamics compared with those who have uncomplicated pregnancies. It also has been suggested that preexisting maternal cardiac changes might drive the development of complications in pregnancy that are associated with impaired placentation. To understand, however, this potential link in complicated pregnancies, it is important to clarify whether placental function is associated with maternal cardiac functional indices in normal pregnancies. To determine whether placental function, perfusion, and fetal weight are associated with maternal cardiac hemodynamic responses at 35-36 weeks of gestation in normal pregnancies. Prospective screening of women attending Kings' College Hospital for routine hospital visit at 35-37 weeks' gestation. We recorded maternal characteristics and measured mean arterial pressure, uterine artery pulsatility index, sonographic estimated fetal weight, and serum placental growth factor and soluble fms-like tyrosine kinase 1. We also performed maternal echocardiogram to assess cardiac output and peripheral vascular resistance as well as indices of diastolic and systolic function, including global longitudinal systolic function and left ventricular mass indexed to body surface area. We studied 1386 women. Maternal characteristics were associated with both maternal hemodynamics and functional and structural indices. Uterine artery pulsatility index was associated with left ventricular mass (P=.03) and global longitudinal systolic function (P=.017). There were significant nonlinear associations between placental growth factor and cardiac output and peripheral vascular resistance (P<.001 for both) and between soluble fms-like tyrosine kinase 1 and peripheral vascular resistance (P=.018). Estimated fetal weight was associated with maternal cardiac output (mean increase=0.186, 95% confidence interval, 0.133-0.238, P<.001) and peripheral vascular resistance (mean decrease=-0.164, 95% confidence interval, -0.217 to -0.111, P<.001). No association was noted between placental and fetal parameters and maternal cardiac functional and structural indices. In multivariable analysis, placental growth factor remained strongly associated with maternal cardiac output and peripheral vascular resistance (P=.002 for both) over and above maternal characteristics and estimated fetal weight. Estimated fetal weight was associated with left ventricular mass (0.102, 95% confidence interval, 0.044-0.162, P=.001). The results of this study suggest a strong link between maternal hemodynamic responses and fetoplacental needs across the whole spectrum in normal pregnancies. These findings would also indicate that to diagnose maternal cardiac dysfunction in pregnancies complicated by impaired placentation a more extensive echocardiographic assessment might be needed rather than relying on hemodynamics which are strongly associated with fetoplacental indices.

Essential Trace Element Status of Pregnant Women with Pregnancy Complication History in Benin City, Nigeria

Essential trace elements are catalytic substances needed by the human body in small amount. The objective of this study was to determine the serum levels of selected essential trace elements (copper, zinc, iron and selenium) in pregnant women with history of pregnancy complications in Benin City, Nigeria using appropriate standard methods for blood. Sample collection and analysed by EAAS. Result showed that pregnant women with complications history had blood mean (mean ± SEM) levels of Copper (µg/l) =107.47± 0.18, Zinc (µg/l) = 86.19 ± 0.41, Iron (µg/l) = 108.50 ± 0.18 and Selenium (µg/l)=42.13± 0.39; while those without complications history had blood mean levels of Copper=125.65 ± 1.60, Zinc =91.91± 0.84, Iron=112.26± 0.33 and Selenium=46.47± 0.32.The non-pregnant women who never had complications in their previous pregnancies had blood mean levels of Copper =129.91± 1.49, Zinc=108.08± 0.52, Iron=136.58± 0.80 and Selenium=51.32 ± 0.10. Pregnant women with complications history recorded very high significant reduction (P&lt;0.001) in the essential trace elements mean values compared to pregnant and non-pregnant women without complications. Reduction in the essential trace elements has negative impact on the development of pregnancy complications among pregnant women in Benin City, Nigeria.Keywords: Essential, Elements, Pregnancy, Complications

The role of odontogenic infection role as a medical justification of planning the individual prevention programs in childbearing age women

Relevance:odontogenic infection plays an important role in the development of pregnancy complications, often causing premature birth of the child, as well as limiting its growth and development. According to studies Figueiredo C., Rosalem C., Cantanhede A. found that during pregnancy, women’s organs undergo various physiological, neurological and hormonal changes that occur gradually. In the process of such a restructuring of the body changes the dental status, which determines the correction stages of individual oral hygiene. According to the study Trigolos N. N., Firsova I. V., Makedonova Y. A. and others determined that dental health improves dental status, eliminates the possibility of exacerbation of chronic odontogenic foci of infection, reduces the risk of fetal infection and development of prenatal and postnatal complications, as well as a positive effect on antenatal prevention of dental diseases of the child.Materials and methods:a total of 216 pregnant women were examined and monitored for a month. To study the hygienic status of women during pregnancy with the pathology of hard tissues of teeth, the hygienic index of green-Vermillion was used. Assessment of the acid-base state of the oral fluid was carried out using the pH meter of the company “Hanna” with a replaceable pH electrode HI 1270. Antimicrobial activity of the hygiene of the mouth was studied with the use of different means of oral hygiene in the process of carrying out hygienic measures to identify maximum efficiency in the selection of funds and the development of “personal hygiene prevention programme”.Results:the assessment showed an increase in the cleansing effect for the entire period of the study in group 1 from 16.90 ± 3.53% to 49.77 ± 5.62%, in group 2 – from 28.19 ± 3.85% to 64.21 ± 6.32%, in contrast to the control – from 16.14 ± 3.21% to 35.87 ± 5.07%. Indicators of changes in acid-base efficiency of oral fluid were in the 1st group 2.50 ± 0.20, in the 2nd group - 3.21 ± 0.20, and in the 3rd group was 2.38 ± 0.20.Conclusion:during pregnancy, it is necessary to choose the right hygiene products to ensure oral health and maintain odontogenic infectious status, which eliminates the risk of preterm birth, which threatens a pregnant woman. The importance of odontogenic infection and ways of prevention in women of childbearing age is determined by the development of measures to strengthen dental health and plays a leading role in the planning of individual programs for the prevention of major dental diseases in women of childbearing age.

Non-invasive prenatal testing reveals copy number variations related to pregnancy complications

BackgroundPregnancy complications could lead to maternal and fetal morbidity and mortality. Early diagnosing and managing complications have been associated with good outcomes. The placenta was an important organ for development of pregnancy complications. Thus, non-invasive prenatal testing technologies could detect genetic variations, such as aneuploidies and sub-chromosomal copy number variations, reflecting defective placenta by maternal plasma cffDNAs. Maternal cffDNAs had been proved to derive from trophoblast cells of placenta.ResultsIn order to find out the relationship between genetic variations and pregnancy complications, we reviewed NIPT results for subchromosomal copy number variations in a cohort of 3890 pregnancies without complications and 441 pregnancies with pregnancy complications including gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preterm prelabor rupture of membranes (PPROM) and placenta implantation abnormalities (PIA). For GDMs, we identified three CNV regions containing some members of alpha- and beta-defensins, such as DEFA1, DEFA3, DEFB1. For PIHs, we found three duplication and one deletion region including Pcdhα, Pcdhβ, and Pcdhγ, known as protocadherins, which were complicated by hypertensive disorders. For PPROMs and PIAs, we identified one and two CNV regions, respectively. SFTPA2, SFTPD and SFTPA1, belonging to surfactant protein, was considered to moderated the inflammatory activation within the fetal extra-embryonic compartment, associated to duration of preterm prelabor rupture of fetal membranes, while MEF2C and TM6SF1 could be involved in trophoblast invasion and differentiation.ConclusionsOur findings gave a clue to correlation between genetic variations of maternal cell-free DNAs and pregnancy complications.

Порівняльний аналіз перебігу вагітності, пологів і стану новонароджених при двійнях з монохоріальним типом плацентації

The objective: to analyze the peculiarities of pregnancy, labour and condition of newborn twins with monochorionic type of placentation. Materials and methods. A comparative analysis of pregnancy, labour and perinatal consequences in 110 cases in monochorionic twins pregnancies (MT) was conducted. The I group consisted of 92 patients who did have obstetric complications specific for multiple pregnancy during pregnancy; in group II 18 pregnant women with specific complications during multiple pregnancy were included. Additionaly, ultrasound fetometry, placentalography, doplerometry, cardiotocography were used. Results. Pregnancy with monochorionic twins is a risk factor for the development of pregnancy complications, and specific complications due to this type of placentation are extremely unfavorable in relation to perinatal outcomes. Even with pathogenetic treatment, there is a high risk of pregnancy loss, premature birth, and the development of pathology in newborns. Analysis of perinatal outcomes showed that in the absence of specific complications of MC type of placentation in 49.0% cases normotrophic children were born, according exceeds the percentage of patients whose children were born with hypotrophy varying severity - 51.0% respectively. In both subgroups pregnancies were characterized by high risk of abortion (61.4% and 67.1% respectively), preeclampsia various severity in 33.3% and 44.6%, gestational anemia in 43.4%, and 39.8%, premature birth, which occurred in 66.7% and 46.8% respectively. This explains the high incidence of operative delivery 44.4% and 52.1% respectively, while the incidence of planned abdominal delivery in subgroup 1b was 3.3 times higher than in subgroup 1a. Perinatal loss in patients with MC twins in subgroups were 4.4% and 5.3% respectively. Conclusion. Pregnancy and delivery of monochorionic twins with specific complications has a higher risk for fetus and newborn, which lead to higher rates of perinatal mortality and morbidity in this group of infants. So searching for effective methods of prevention and treatment of these complications is required. The results should be considered during making algorithm of diagnostic and preventive measures in multiple pregnancies. Key words: monochorionic twins, labour, perinatal consequences.

Correlation of tumor necrosis factor alpha, interleukin 6 and interleukin 10 with blood pressure, risk of preeclampsia and low birth weight in gestational diabetes.

Several pathophysiological mechanisms have been proposed in the development of pregnancy complications, including endothelial dysfunction, an inflammatory pathway and oxidative stress. The aim of the present study was to evaluate the correlation between proinflammatory cytokines TNF-alpha, IL-6 and dual cytokine IL-10 in the mother's peripheral blood and systolic blood pressure, risk of preeclampsia and low birth weight in gestational diabetes (GDM). We observed 40 women with GDM divided into a gestational hypertension group (n=20) and comparison group (n=20) with normal blood pressure. We found a significant positive correlation between TNF-alpha; IL-6; IL-10 levels and systolic blood pressure (SBP) in the second trimester (p<0.001; p<0.001; p<0.001); the third trimester (p<0.001; p<0.001; p<0.05). We also proved correlations for diastolic blood pressure (DBP) during the second; third trimester (p<0.001; p<0.001; p<0.001); (p<0.001; p<0.001; p<0.0015). We demonstrated a statistically significant positive association between high TNF-alpha group and preeclampsia risk in the third trimester (p=0.04). We also determined the negative correlation in the second trimester between birth weight and TNF-alpha; IL-6, IL-10 levels (p<0.05; p<0.001; p<0.001). To conclude, our data highlight the importance of cytokines TNF-alpha, IL-6 and IL-10 in blood pressure regulation. In addition, high levels of TNF-alpha have been associated with increased risk of preeclampsia. We found a significant negative correlation between levels of TNF-alpha, IL-6, IL-10 and birth weight.

Association of first-trimester HbA1c levels with adverse pregnancy outcomes in different ethnic groups

AimTo determine, in a multi-ethnic cohort, the association of first-trimester HbA1c levels with the development of pregnancy complications. MethodsA prospective study between April 2013–October 2016. Participants were stratified in five ethnic groups. Women had an HbA1c measurement added to their first antenatal bloods. Primary outcome was macrosomia and secondary outcomes included preeclampsia and large-for-gestational age (LGA). A multivariate logistic regression analysis was performed to adjust for potential confounders in determining the association between different HbA1c cut-off points and obstetric outcomes on each ethnic group. Results1,882 pregnancies were included. Analysis was limited to the three main ethnic groups: Caucasian (54.3%), South-Central Asian (19%) and Latin-American (12.2%). There was no association between HbA1c levels and obstetric outcomes among Caucasians. In Latin-Americans, an HbA1c ≥ 5.8% (40 mmol/mol) was associated with higher risk of macrosomia, whereas an HbA1c ≥ 5.9% (41 mmol/mol) was associated with LGA. In South-Central Asian, an HbA1c ≥ 5.7% (39 mmol/mol) was associated with increased risk of macrosomia and a continuous graded relationship between HbA1c levels and preeclampsia and LGA was detected starting at HbA1c levels of 5.4% (36 mmol/mol). ConclusionFirst-trimester HbA1c levels perform as a suitable predictor of pregnancy complications in South-Central Asian and Latin-American women whereas in Caucasian no significant associations were found.

ФОЛАТНЫЙ ЦИКЛ: ПАТОГЕНЕТИЧЕСКИЕ МЕХАНИЗМЫ ОСЛОЖНЕНИЙ БЕРЕМЕННОСТИ (ЛИТЕРАТУРНЫЙ ОБЗОР)

The problem of prevention of complicated course of pregnancy and childbirth takes a leading place in modern obstetrics and perinatology. The authors conducted a profound analysis of numerous clinical studies in the area of folate metabolism in general, its role in the reproductive health of women, gestational complications, and the formation of fetal pathology. The significance of folic acid deficiency which is related to diet peculiarities, to insufficient enzymes intake, as well as to defects in folate exchange genes, which determine the reduced enzyme activity, is evaluated. In recent years, there has been much evidence that mutant homozygous (TT) and heterozygous (CT) genotypes are much more common among women with complicated pregnancies. Genetic deficiency of the key enzyme of the folate cycle – methylene-tetra-hydro-folate-reductase (MTHFR) is one of the reasons of hyperhomocysteinemia that has a pronounced toxic effect, damages the endothelial lining of the blood vessels and triggers a disorder of the processes of coagulation. Hyperhomocysteinemia has a big influence on the development of pregnancy complications, which depend on microcirculation, starting with spontaneous miscarriage in the first trimester of pregnancy and ending with preeclampsia, premature placental abruption and intrauterine fetal death. The consequences of the folate cycle problems at different stages can be congenital malformations of the fetus, especially defects of the neural tube. The importance of folic acid in the pathogenetic mechanisms of anemia is described. An interesting question is the role of low-functional alleles of folate genes in reproductive function disorders: under condition of infertility and miscarriage. The presented literature review is a reasonable conclusion for the need of further study of folate metabolism, taking into account genetic predisposition and other components.

Effects of consuming sugars and alternative sweeteners during pregnancy on maternal and child health: evidence for a secondhand sugar effect.

Consumption of sugar and alternative low- or no-energy sweeteners has increased in recent decades. However, it is still uncertain how consumption of sugar and alternative sweeteners during pregnancy affects pregnancy outcomes and long-term offspring health. This review aims to collate the available evidence surrounding the consequences of sugar and alternative sweetener consumption during pregnancy, a so-called secondhand sugar effect. We found evidence that sugar consumption during pregnancy may contribute to increased gestational weight gain and the development of pregnancy complications, including gestational diabetes, preeclampsia and preterm birth. Further, we found a growing body of the animal and human evidence that maternal sugar intake during pregnancy may impact neonatal and childhood metabolism, taste perception and obesity risk. Emerging evidence also suggests that both maternal and paternal preconception sugar intakes are linked to offspring metabolic outcomes, perhaps via epigenetic alterations to the germline. While there have been fewer studies of the impacts of alternative sweetener consumption before and during pregnancy, there is some evidence to suggest effects on infant outcomes including preterm birth risk, increased infant body composition and offspring preference for sweet foods, although mechanisms are unclear. We conclude that preconception and gestational sugar and alternative sweetener consumption may negatively impact pregnancy outcomes and offspring health and that there is a need for further observational, mechanistic and intervention research in this area.

FEATURES OF CONNECTIVE TISSUE METABOLISM AND MICROELEMENTS IN BLOOD SERUM OF PREGNANT WOMEN WITH CERVICAL INSUFFICIENCY

The preterm deliveries are the leading cause of the perinatal morbidity and represent important mortality indicators. Functional cervical insufficiency, which is a phenotypic manifestation of undifferentiated connective tissue dysplasia, plays the main role in the development of pregnancy complications in primigravidas (women pregnant for the first time) and primiparas (women giving birth for the first time). Aim of the research: to study the indicators of connective tissue metabolism and basic microelements in order to determine the role of undifferentiated connective tissue dysplasia in the pathogenesis of functional cervical insufficiency during pregnancy. Methods. The 101 pregnant women (the main group) at the 22–32 week gestation period which were diagnosed with “Functional cervical insufficiency” were examined, as well as 34 pregnant women with the physiological obstructive function of the cervix (the control group). Utilizing immunoenzyme analysis we measured in blood serum the concentration of Total P1NP the amino-terminal propeptide of procollagen type I a marker of synthesis, and β-CrossLaps resorptions marker of the connective tissue. Utilizing the automatic analyzer of electrolytes and a set of reagents for their determination we estimated the content of microelements Na+, K+, Mg2+, Ca2+ and total Ca and P. Results. The functional cervical insufficiency in pregnant women was indicated by cervical shortening up to 22.88±1.02 mm, and the majority of women (76.2 %) had phenotypical manifestations of undifferentiated connective tissue dysplasia. We found a significant increase in the concentration of marker of synthesis Total P1NP, whereas the concentration of resorption marker β-CrossLaps remains normal, and strong reverse correlation (r=–0.7362) between the index of cervix length and concentration of marker of connective tissue synthesis Total P1NP. We detected a significant increase in the concentration of total and ionized calcium, total phosphorus, deficiency of ionized magnesium, potassium and sodium that lead to changes in the structure of connective tissue and reduction of cervical obstructive function.

The influence of specific mutations in the AT gene (SERPINC1) on the type of pregnancy related complications

BackgroundInherited antithrombin (AT) deficiency is a rare autosomal dominant disorder, caused by mutations in the SERPINC1 gene. The most common clinical presentation in AT deficient patients includes venous thrombosis and pulmonary embolism, while the association of AT deficiency and its effect on the development of pregnancy complications has been less studied. The aim of our research was to evaluate the effect of AT deficiency types, determined by genotyping, on pregnancy outcomes. MethodsA retrospective cohort study included 28 women with AT deficiency, and their 64 pregnancies were analyzed. ResultsWith regard to live birth rate, a significant difference was observed among women who were carriers of different SERPINC1 mutations, as the rate varied from 100% in cases of type I to the extremely low rate of 8% for women with type II HBS (AT Budapest 3) in the homozygous variant, P = 0.0005. All pregnancies from the type I group, even untreated ones, resulted in live births. In women with AT Budapest 3 in homozygous variant the overall live birth rate increased to 28.5% in the treated pregnancies. In this group the highest incidence of fetal death was observed of 62%; repeated fetal losses in 30%; fetal growth restriction in 22% and placental abruption in 7% of all pregnancies. ConclusionOur study results indicate a difference between type I and type II AT deficiency. The risk of pregnancy related VTE was equally present in both groups, except for AT Budapest 3 in the heterozygous variant, while adverse pregnancy outcomes were strictly related to type II, especially AT Budapest 3 in the homozygous variant.

Risk factors for adverse pregnancy outcomes in women with intrahepatic cholestasis of pregnant women

Intrahepatic cholestasis of pregnant women (ICPW) is associated with an increased risk of complications of pregnancy. Objective prognostic markers of adverse pregnancy outcomes except for a high level of bile acids (BA) in the mother's blood serum, exceeding 40 μmol/l, do not currently exist. However, the determination of the BA levels is not available in all laboratories, which indicates the need to search for other informative prognostic markers of complications of pregnancy in patients with ICPW. Objective: to determine the risk factors for adverse pregnancy outcomes in ICPW. Materials and methods. A prospective study included 97 pregnant women diagnosed with ICPW. The diagnosis was established with an increase in the serum level of the BA in excess of 10 μmol/l. Patients underwent clinical and laboratory examinations with assessment of biochemical markers of liver damage, antioxidant status (determination of superoxide dismutase, glutathione peroxidase, selenium, zinc level). Biochemical indices and severity of pruritus were assessed at the time of diagnosis of ICPW, after 1 and 2 weeks of treatment with ursodeoxycholic acid (UDCA) at a dose of 500 mg to 2 g per day. In the study of perinatal outcomes, the term of delivery, the method of delivery, the presence of signs of intrauterine fetal hypoxia, the state of the fetus at the time of birth were taken into account. Results of the study. In the observed group of patients, the incidence of preterm birth was 31.9%, intrauterine fetal hypoxia 29.9%, pre-eclampsia 23.7%, the need for a cesarean section due to the development of pregnancy complications arose in 40 (41.2%) cases. The risk factors for complications of pregnancy in patients with ICPW were: early onset and longer duration of ICPW, reactivation of cholestasis after its regression against the background of UDCA treatment and less effective treatment of skin itching in patients with manifest forms of ICPW. The laboratory markers of adverse pregnancy outcomes were a high level of maternal total serum BA and a low efficiency of its reduction against the background of treatment, a slow rate of decrease in hepatic transaminase activity against the background of treatment, a low level of antioxidant protection enzymes. The use of sex hormones during pregnancy promoted more frequent development of preeclampsia and increased the frequency of indications for cesarean delivery. The conclusion. Patients with early manifestation of ICPW and reactivation of cholestasis after its regression on the background of treatment, low effectiveness of treatment of pruritus, and also taking drugs of sex hormones require special attention and active management in connection with an increased risk of complications of pregnancy. It is advisable to carry out dynamic monitoring of the level of BA, hepatic transaminases and antioxidant enzymes in dynamics against the backdrop of treatment with ICPW to assess the effectiveness of treatment and timely prediction of possible complications of pregnancy.

Роль плацентарных экзосом в развитии осложнений беременности

Роль плацентарных экзосом в развитии осложнений беременности

Prognostic Significance of Preterm Isolated Decreased Fetal Movement

Objective: Our aim is to evaluate the prognostic significance of isolated, preterm decreased fetal movement following normal initial full diagnostic workup.Study design: A retrospective observational study was conducted at a tertiary centre. The applied protocol was approved by the Medical Research Ethics Department of the hospital where the research was conducted. Obstetrics outcomes of preterm- and term-decreased fetal movement were compared following an initial, normal diagnostic work up. Evaluated outcomes were birth weight, mode of delivery, stillbirth rate, induction of labour, development of gestational hypertension, small for gestational age and oligohydramnios, polyhydramnios during the follow up period.Result: Obstetric complications related to placental insufficiency develops more frequently for decreased fetal movement in preterm cases with respect to that of in term cases. Following the diagnosis of decreased fetal movement, pregnancy hypertension occurred in 17% of preterm decreased fetal movement cases and in 4.7% of term decreased fetal movement cases. Fetal growth restriction developed in 6.6% of preterm decreased fetal movement and in 2.3% of term decreased fetal movement. Amniotic fluid abnormalities more frequently developed in preterm decreased fetal movement.Conclusion: Following an initial normal diagnostic workup, preterm decreased fetal movement convey a higher risk for the development of pregnancy complications associated with placental insufficiency. The patient should be monitored closely and management protocols must be developed for initial normal diagnostic workups in cases of preterm decreased fetal movement.

Роль системного воспаления в развитии осложнений беременности у женщин с ожирением

Роль системного воспаления в развитии осложнений беременности у женщин с ожирением

The influence of prenatal exercise and pre-eclampsia on maternal vascular function.

During healthy pregnancy, the cardiovascular system undergoes diverse adaptations to support adequate transfer of oxygen and nutrients from mother to fetus. In order to accommodate the large expansion of blood volume and associated cardiac output, the structure, mechanics, and function of the arteries are altered. Specifically, in healthy pregnancy there is a remodeling of arteries (increased angiogenesis and vasodilation), a generalized reduction in arterial stiffness (increased compliance), and an enhanced endothelial function. The development of pregnancy complications, specifically pre-eclampsia, is associated with poor placentation (decreased angiogenesis), increased arterial stiffness, and vascular dysfunction (reduced endothelial function). Many of the positive adaptations that occur in healthy pregnancy are enhanced in response to chronic exercise. Specifically, placental angiogenesis and endothelial function have been shown to improve to a greater extent in women who are active during their pregnancy compared with those who are not. Prenatal exercise may be important in helping to reduce the risk of vascular dysfunction in pregnancy. However, our knowledge of the vascular adaptations resulting from maternal exercise is limited. This review highlights maternal vascular adaptations occurring during healthy pregnancy, and contrasts the vascular maladaptation associated with pre-eclampsia. Finally, we discuss the role of prenatal exercise on vascular function in the potential prevention of vascular complications associated with pre-eclampsia.

Predictive technologies and possibilities of molecular genetics in reproductive medicine

The main goal of predictive medicine is to uncover risk factors of a disease to prevent its development and cure it at early stages. At present, the dominant role in disease prevention is attributed to genetics, the modern opportunities of which make it possible to assess the risk of the development of pathological processes. The tasks of predictive technologies in reproductive medicine are the development and introduction of early prophylactic measures to prevent a pregnancy with a genetically pathological fetus and the delivery of a child with an inborn hereditary pathology and to exclude the development of pregnancy complications.

Гіперглікозильований хоріонічний гонадотропін – прогностичний критерій розвитку ускладнень вагітності

The objective: to assess the prognostic significance of the level of serum hyperglycosylated human chorionic gonadotropin (gHCG) reative to the development of pregnancy complications that lead to impaired fetal conditions. Materials and methods. 382 pregnant women were examined who were on the register, were hospitalized in case of complications of pregnancy and gave birth to KCMH №2 (Kiev). All pregnant women were evaluated serum gCGG in the period of 8-10 weeks gestation, evaluated the course and result of pregnancy. Results. Reduction in the level of gHCG is a marker of insufficient trophoblast invasion, which is likely to lead to the formation of placental dysfunction and the development of a variety of obstetric pathology complicating the course of pregnancy and a risk factor for antenatal loss and neonatal morbidity. The conclusion. Determination of the level of hyperglycosylated human chorionic gonadotropin in the first trimester of pregnancy will make it possible to identify pregnant women at risk for the formation of placental dysfunction and propose a set of monitoring activities aimed at early detection of violations of pregnancy and their timely removal. This helps prevent the formation of severe pathological conditions during pregnancy in both the mother and the fetus, which corresponds to the current trends in the development of medical care, namely: prediction, prevention and individual approach. Key words: hyperglycosylated chorionic gonadotrophin, complications of pregnancy, disturbed fetal condition.

Effects of maternal obesity on placental function and fetal development.

Obesity has reached epidemic proportions, and pregnancies in obese mothers have increased risk for complications including gestational diabetes, hypertensive disorders, pre-term birth and caesarian section. Children born to obese mothers are at increased risk of obesity and metabolic disease and are susceptible to develop neuropsychiatric and cognitive disorders. Changes in placental function not only play a critical role in the development of pregnancy complications but may also be involved in linking maternal obesity to long-term health risks in the infant. Maternal adipokines, i.e., interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), leptin and adiponectin link maternal nutritional status and adipose tissue metabolism to placental function. Adipokines and metabolic hormones have direct impact on placental function by modulating placental nutrient transport. Nutrient delivery to the fetus is regulated by a complex interaction including insulin signaling, cytokine profile and insulin responsiveness, which is modulated by adiponectin and IL-1β. In addition, obese pregnant women are at risk for hypertension and preeclampsia with reduced placental vascularity and blood flow, which would restrict placental nutrient delivery to the developing fetus. These sometimes opposing signals regulating placental function may contribute to the diversity of short and long-term outcomes observed in pregnant obese women. This review focuses on the changes in adipokines and obesity-related metabolic hormones, how these factors influence placental function and fetal development to contribute to long-term metabolic and behavioral consequences of children born to obese mothers.

ДЕФІЦИТ ВІТАМІНУ D І ВАГІТНІСТЬ.

У статті наведені дані щодо сучасних поглядів на роль вітаміну D у забезпеченні різноманітних функцій організму і, зокрема, ролі дефіциту вітаміну D у розвитку ускладнень вагітності. Показано багатогранність функцій вітаміну D та вплив його дефіциту на низку акушерських і перинатальних ускладнень. Вказано на необхідність скринінгового цілеспрямованого обстеження вагітних на вміст вітаміну D у сироватці крові, що дозволить проводити вчасну корекцію та попередити ускладнення.