Development Of Pregnancy Complications Research Articles

When autophagy meets placenta development and pregnancy complications.

Autophagy is a common biological phenomenon in eukaryotes that has evolved and reshaped to maintain cellular homeostasis. Under the pressure of starvation, hypoxia, and immune damage, autophagy provides energy and nutrients to cells, which benefits cell survival. In mammals, autophagy is an early embryonic nutrient supply system involved in early embryonic development, implantation, and pregnancy maintenance. Recent studies have found that autophagy imbalance in placental tissue plays a key role in the occurrence and development of pregnancy complications, such as gestational hypertension, gestational obesity, premature birth, miscarriage, and intrauterine growth restriction. This mini-review summarizes the molecular mechanism of autophagy regulation, the autophagy pathways, and related factors involved in placental tissue and comprehensively describes the role of autophagy in pregnancy complications.

Early to mid-pregnancy HbA1c levels and its association with adverse pregnancy outcomes in three low middle-income countries in Asia and Sub-Saharan Africa

BackgroundHyperglycemia during pregnancy leads to adverse maternal and fetal outcomes. Thus, strict monitoring of blood glucose levels is warranted. This study aims to determine the association of early to mid-pregnancy HbA1c levels with the development of pregnancy complications in women from three countries in South Asia and Sub-Saharan Africa.MethodsWe performed a secondary analysis of the AMANHI (Alliance for Maternal and Newborn Health Improvement) cohort, which enrolled 10,001 pregnant women between May 2014 and June 2018 across Sylhet-Bangladesh, Karachi-Pakistan, and Pemba Island-Tanzania. HbA1c assays were performed at enrollment (8 to < 20 gestational weeks), and epidemiological data were collected during 2–3 monthly household visits. The women were followed-up till the postpartum period to determine the pregnancy outcomes. Multivariable logistic regression models assessed the association between elevated HbA1c levels and adverse events while controlling for potential confounders.ResultsA total of 9,510 pregnant women were included in the analysis. The mean HbA1c level at enrollment was found to be the highest in Bangladesh (5.31 ± 0.37), followed by Tanzania (5.22 ± 0.49) and then Pakistan (5.07 ± 0.58). We report 339 stillbirths and 9,039 live births. Among the live births were 892 preterm births, 892 deliveries via cesarean section, and 532 LGA babies. In the multivariate pooled analysis, maternal HbA1c levels of ≥ 6.5 were associated with increased risks of stillbirths (aRR = 6.3, 95% CI = 3.4,11.6); preterm births (aRR = 3.5, 95% CI = 1.8–6.7); and Large for Gestational Age (aRR = 5.5, 95% CI = 2.9–10.6).ConclusionMaternal HbA1c level is an independent risk factor for predicting adverse pregnancy outcomes such as stillbirth, preterm birth, and LGA among women in South Asia and Sub-Saharan Africa. These groups may benefit from early interventional strategies.

Fetal-maternal interactions during pregnancy: a 'three-in-one' perspective.

A successful human pregnancy requires the maternal immune system to recognize and tolerate the semi-allogeneic fetus, allowing for appropriate trophoblasts invasion and protecting the fetus from invading pathogens. Therefore, maternal immunity is critical for the establishment and maintenance of pregnancy, especially at the maternal-fetal interface. Anatomically, the maternal-fetal interface has both maternally- and fetally- derived cells, including fetal originated trophoblasts and maternal derived immune cells and stromal cells. Besides, a commensal microbiota in the uterus was supposed to aid the unique immunity in pregnancy. The appropriate crosstalk between fetal derived and maternal originated cells and uterine microbiota are critical for normal pregnancy. Dysfunctional maternal-fetal interactions might be associated with the development of pregnancy complications. This review elaborates the latest knowledge on the interactions between trophoblasts and decidual immune cells, highlighting their critical roles in maternal-fetal tolerance and pregnancy development. We also characterize the role of commensal bacteria in promoting pregnancy progression. Furthermore, this review may provide new thought on future basic research and the development of clinical applications for pregnancy complications.

Impact of first-trimester body mass index on pregnancy outcomes: observational study

The epidemic of obesity is gradually becoming a global health concern across all age groups. In pregnant mothers, overweight or obesity have been known to be associated with significant antenatal, intrapartum, postpartum, and neonatal complications. Therefore, this study aimed to investigate the association between high maternal Body Mass Index (BMI) and adverse pregnancy outcomes. This was a longitudinal observational study done at the Lagos University Teaching Hospital between May 2019 and February 2020. Antenatal women with gestational age &lt;12 weeks with singleton pregnancies were recruited for the study. They were followed up throughout pregnancy and postpartum to assess for complication during pregnancy, labour, and puerperium. A total of 568 pregnant women were involved in the study. Five hundred and fifty six (556) had complete data and were included in the data analysis. Of these, 169 (30.4%) had BMI of 30 and above while 387 (69.6%) had BMI&lt;30. Women with BMI of 30 and above had significant (p&lt;0.05) risk for development of complications in pregnancy. There is an obvious association between increased maternal BMI and adverse pregnancy outcomes. Public health implications of obesity are enormous for both the mother and baby during pregnancy and delivery. Preconception counselling and health education programs may be beneficial in order to maintain normal BMI in women of reproductive age.

Ассоциация полиморфизма генов ферментов фолатного цикла и риска развития осложнений беременности

Polymorphisms in the genes of folate cycle enzymes are considered as the main cause of reduced plasma levels of folate and vitamin B12, impaired homocysteine metabolism, and the development of pregnancy complications. Objective. To study the association of polymorphism in folate cycle enzyme genes, MTHFR-677C&gt;T, MTHFR-1298A&gt;C, MTR‑2756A&gt;G, MTRR-66A&gt;G, with the risk of pregnancy complications. Patients and methods. The study was conducted in outpatient settings and included 96 women aged between 20 and 40 years with a history of 1 to 3 pregnancies who applied for preconception care. Results. When examining the association between the presence of a complicated history in this group of women and folate cycle enzyme gene polymorphisms using the Fisher test, a statistically significant correlation was detected for MTHFR-677C&gt;T, MTHFR-1298A&gt;C, MTR-2756A&gt;G, and MTRR-66A&gt;G. Conclusion. The presence/absence of genetic polymorphisms of folate cycle enzymes should be considered when predicting the risks of pregnancy complications and developing a personalized preconception care program to select individual regimens of folate supplementation. Key words: genes, folate cycle, polymorphism, folates, pregnancy

Vitamin D Deficiency is Associated With Increased Plasminogen Activator Inhibitor 1/Plasminogen Activator Inhibitor 2 Ratio in Pregnancy.

Vitamin D deficiency has recently been suggested as an independent risk factor for thrombosis. Notably, vitamin D deficiency is common in pregnant populations, whom already have an increased thrombotic risk. However, pregnant women are commonly excluded from studies investigating the hemostatic system, and knowledge on the impact of vitamin D on hemostasis in pregnancy is therefore limited. A cross-sectional study comparing the hemostatic profile of pregnant women (gestational week 12.9 ± 0.7) with vitamin D deficiency (≤50 nmol/L) (n = 70) and high adequate vitamin D status (≥100 nmol/L) (n = 59). Vitamin D deficient women displayed increased plasminogen activator inhibitor 1 levels and an increased plasminogen activator inhibitor 1/plasminogen activator inhibitor 2 ratio, even after adjusting for factors with potential influence on hemostasis (body mass index, smoking and use of fish oil supplements). Vitamin D deficiency is associated with increased plasminogen activator inhibitor 1/plasminogen activator inhibitor 2 ratio in pregnant women. As an increased plasminogen activator inhibitor 1/plasminogen activator inhibitor 2 ratio with high plasminogen activator inhibitor 1 levels may increase thrombotic risk and is associated with the development of pregnancy complications, further research is needed to determine the optimal vitamin D supplementation in pregnancy.

First effects of the COVID-19 pandemic: pregnancy complications, newborn health and expected reproductive losses

Introduction. The pandemic of the novel coronavirus infection COVID-19 (NCI) has posed a number of questions for humanity, starting with the impact of the infection on the ability of fetation in a couple, pregnancy outcomes, its complications, and ending with the impact on the health of future generations, including the reproductive one.Aim. To analyze the register of pregnant women and newborns in the Amur Region with NCI to identify immediate complications of pregnancy and the neonatal period.Materials and methods. An analysis was made of the registry of pregnant women (n=966) with NCI, newborns from mothers with NCI (n=111) and infected from family members (n=21) in the period from May 1, 2020 to January 1, 2022. A general clinical study of pregnant women and newborns was performed, as well as an analysis of the vaccination of women registered for pregnancy in 2022. Standard statistical data processing methods were used.Results. 966 women were registered who underwent NCI during pregnancy, which accounted for 6.13% of all births, of which in 2020 – 16.9%, in 2021 –83%. In the Amur Region, the maternal mortality rate, as in the Russian Federation, increased during the pandemic and amounted to 38.2 in 2020, and 68.1 per 100 000 population in 2021; particularly from COVID-19 in 2020 – 12.8, in 2021 – 40.9 per 100 thousand population. At the same time, 17.8% had an asymptomatic course of the disease, 63.4% had a mild course, 17.7% had a moderate course, and 11.14% had a severe course with pathological changes in the lungs. The risk of lung tissue damage was increased by infection in the third trimester of pregnancy (RR – 1.73; 95% CI: 1.04-2.9), age over 30 years (RR – 1.24; 95% CI: 1.01-1 .53), overweight (RR –1.8; 95% CI: 1.5–2.14), and obesity (RR – 1.53: 95% CI: 1.2–1.8). The risk of developing complications of pregnancy significantly increased in women with pathological changes in the lungs (moderate and severe course), in comparison with pregnant women with mild NCI. It was found that 14.4% of newborns from mothers with NCI were born prematurely, 3.6% – in moderate asphyxia. The vertical transmission path was not registered in any case. In 33% of children infected in the neonatal period, NCI proceeded in the moderate, in 67% – in mild severity. Only one in three pregnant women are currently vaccinated. Of these, at the stage of preconception preparation, 77%, during pregnancy – 23%.Conclusion. NCI is a factor in the severe course of the disease and the development of pregnancy complications in women with pathological changes in the lungs, which increases the risk of maternal and infant mortality.

Clinical indicators of red blood in pregnant women with bacterial and COVID-19-associated community-acquired pneumonia

Introduction. Community-acquired pneumonia (CAP) is associated with the development of anemia and its clinical manifestations: hypoxemia and hypoxia, which complicates the course of the disease and leads to the development of adverse pregnancy outcomes. The studies are lack of a comparative description of the main laboratory signs of anemia in pregnant women with COVID-19-associated and bacterial CAP, which has a theoretical and applied significance.Aim. To carry out a comparative analysis of the clinical indicators of red blood in pregnant women with COVID- 19-associated and bacterial CAP.Materials and methods. 140 pregnant women were studied in the third trimester of pregnancy, of which 100 participants had CAP of moderate severity (main group) and with uncomplicated pregnancy – 40 (comparison group). The main group included 47 pregnant women with bacterial CAP and 53 participants with COVID-19-associated CAP. All pregnant women were comparable in age and duration of pregnancy. Bacteriological studies of sputum, detection of SARS-Cov-2 RNA in swabs from the oropharynx and nasopharynx by PCR, microscopy of peripheral blood smears, and a clinical blood test were performed.Results. In pregnant women with COVID-19-associated CAP, compared with pregnant women with bacterial CAP, a number of differences were revealed in laboratory parameters that determine the development of anemia: the total number of erythrocytes was reduced by 1.22 times (p&lt;0.001) and hemoglobin concentration by 1.1 times (p&lt;0.05), the percentage of echinocytes was increased by 1.14 times (p&lt;0.05) and degenerative forms of erythrocytes by 1.16 times (p&lt;0.05).Conclusion. In pregnant women with COVID-19-associated CAP, compared with pregnant women with bacterial CAP, significant changes in the number and morphological composition of erythrocytes, hemoglobin concentration were revealed, indicating a high risk of developing anemia and concomitant hypoxemia and hypoxia, which adversely affects the course of the disease and leads to development of pregnancy complications.

Gestation complications in women with metabolic syndrome: pathogenesis, diagnosis and prevention (literature review)

The article summarizes modern scientific views on the main links of pathogenesis, diagnostic criteria and methods for the prevention of gestational complications in women with metabolic syndrome. The aims of study is to analyze modern domestic and foreign studies on the study of pathogenetic mechanisms of influence of metabolic components syndrome for the development of gestational complications, methods of their diagnosis and prevention in women with metabolic syndrome. Results. It has been proven that the components of metabolic syndrome are associated with the development of pregnancy complications, such as pre-eclampsia, fetal growth retardation and macrosomia, gestational diabetes, preterm labour, fetal death, habitual early termination of pregnancy. On the basis of joint pathogenesis, the above-mentioned complications belong to the group of «the great obstetrical syndromes». It has been shown that pregnant women with metabolic syndrome are at high risk for the occurrence of «the great obstetrical syndromes» and require timely appointment of preventive measures to reduce them. Almost all scientific studies have demonstrated the importance of regulating metabolic processes in the body of a woman with metabolic syndrome at the stage of preconcepence period. It is reported that a lifestyle modification that aims to reduce body weight by prescribing a balanced low-calorie diet combined with exercise and the use of behavioral therapy leads to improved pregnancy outcomes for both mother and baby. The conclusion. The problem of metabolic syndrome in women of reproductive age remains relevant in modern medicine and taking into account its social significance, requires further research in the aspect of studying pathogenesis, early diagnosis and prevention of his pathology, since it can significantly improve the condition of the pregnant woman in the future and have a positive effect on the course of pregnancy and childbirth. No conflict of interest was declared by the authors. Keywords: metabolic syndrome, pregnancy, gestational complications, diagnosis, pathogenesis, prevention.

Pregnancy After Simultaneous Pancreas-Kidney Transplantation in Treatment of End-Stage Diabetes Mellitus: a Review.

The majority of patients with simultaneous pancreas and kidney transplant (SPKT) required transplantation owing to a long-standing history of insulin-dependent diabetes mellitus (IDDM). The disease causes multiple organ damage, impairs fertility, and affects quality of life. A successful kidney and pancreas transplant can improve health, ameliorate the consequences of pre-existent diabetes, and restore fertility. Good graft function, without any sign of rejection, and stable doses of immunosuppressant drugs are of utmost importance prior to the planned pregnancy. SPKT recipients who become pregnant may be at an increased risk for an adverse outcome and require meticulous multidisciplinary surveillance. We present experiences with SPKT pregnancies, traditional approaches, and recent considerations. In light of complex interactions between new anatomic relations and the impact of developing pregnancy and immunosuppressive medications, special stress is put on the risk of graft rejection, development of pregnancy complications, and potential harmful effects on fetal development. Recent recommendations in management of SPKT recipients who wish to commence pregnancy are presented as well. Key words: transplantation, pregnancy, pancreas, kidney, simultaneous pancreas and kidney transplantation (SPKT).

Predicting the Development of Great Obstetric Syndromes Based on Multilocus Genetic Analysis: Results of a Retrospective Comparative Cohort Study

Background. Great obstetric syndromes are pathological conditions, related to the level of maternal, perinatal and infant morbidity and mortality. There is a genetic component in the development of pregnancy complications, as evidenced by numerous clinical observations and research results. Purpose to study the frequency characteristics of the occurrence of polymorphic variants of various genes and their combinations in patients who underwent pregnancy complicated by great obstetric syndromes in comparison with women whose pregnancy proceeded without complications and successfully ended with the birth of a live full-term baby. Methods. A retrospective comparative cohort study was conducted. Molecular genetic research was carried out in 391 women: 279 women who underwent one of the verified clinical forms related to great obstetric syndromes (main group), 112 women were included in the control group. 37 polymorphisms in 33 genes were studied (FGB, F2, F5, F7, F13, GPIa, GPIIIa, GPVI, PROC, PAI1, PLAT, MTHFR, MTHFD, MTRR, MTR, SLC19A1, CBS, NOS3, END1, ACE, ADD1, AGT , CYP11B2, GSTM, GSTT, GSTP1, MnSOD, GPX1, IL1, TNF-a, ESR1, ESR2, PGR). Results. The most significant polymorphisms and their combinations were identified. In the main group, the following combinations were more common: ACE Alu I/D ID + AGT А704G GG, AGT А704G GG + MTRR A66G AG, F7 G10976A GG + AGT А704G GG, F7 G10976A GG + F13 G103A GG, F7 G10976A GG + GPIa С807T CC, F7 G10976A GG + MTHFR C677T CC, CYP11B2 G-344A GA + IL1 G+3953A GA, PAI1-657 5G/4G 5G4G + IL1 G+3953A AA, PAI1-657 5G/4G 4G4G + IL1 G+3953A AA, in control group AGT A704G AA + MTRR A66G AG, AGT A704G AG + MTRR A66G AG (the differences are statistically significant). To simplify the practical application of the analysis for genetic polymorphisms, a computer program named GOS RISK was created to assess the risk of pregnancy complications. The sensitivity and specificity were 70.8% and 78.8%, the efficiency of the method 74.8%. Conclusion. Analysis of individual polymorphic variants of genes indicates their role in the discussed pathology. Creation of computer programs based on multilocus genome analysis increases the predictive value of molecular genetic studies.

Gestation in patients with a combination of antiphospholipid and torch syndromes

Aim. To study the features of gestation in women with a combination of antiphospholipid and TORCH syndromes in relation to preconception care.Materials and Methods. We analyzed 137 medical records of women with a past medical history of pregnancy loss and antiphospholipid syndrome (APS), focusing on the presence or absence of plasmapheresis in the preconception period, and further ranking the patients into 2 subgroups (with and without TORCH syndrome). As a control group, we included 28 pregnant women without both syndromes.Results. Gestation in women with combined APS and TORCH syndromes was accompanied by a 10-fold higher risk of threatened abortion in the first trimester and 3-fold higher risk of placental insufficiency as compared to those without both syndromes. Notably, the combination of the syndromes doubled the risk of placental insufficiency in comparison with APS alone. The lack of plasmapheresis in patients with APS and TORCH syndrome was associated with &gt; 2-fold higher risk of threatened abortion. Further, in patients with APS and TORCH syndrome, lack of plasmapheresis increased the likelihood of developing fetal hypoxia by a factor of 2 and 3 in comparison with those diagnosed with APS alone or control patients.Conclusions. TORCH syndrome is a major risk factor of adverse outcome in pregnant women with APS. Inclusion of plasmapheresis into the preconception care in women with APS and TORCH syndrome significantly reduced the development of pregnancy complications.

Патогенетичне значення інсулінорезистентності та ендотеліальної дисфункції у розвитку ускладнень вагітності у жінок з ожирінням та прееклампсією

The purpose of the study was to analyze the effect of insulin resistance and endothelial dysfunction on the development of pregnancy complications in a group of obese women and women with pre-eclampsia. Materials and methods. To achieve this goal, we examined 393 pregnant women on the basis of the Poltava city clinical maternity hospital at the early (9-13 weeks) and later gestation (34-38 weeks). Pregnant women according to a degree of obesity and presence of pre-eclampsia were devided into three groups: the first group – 149 pregnant women with obesity of the first degree, the second group – 73 pregnant women with obesity of the second degree, the third group – 46 pregnant women with obesity of the third degree, the fourth group – 6 pregnant women with physiological body weight and pre-eclampsia, the fifth group – 6 pregnant women with obesity of the first degree and pre-eclampsia, the sixth group – 6 pregnant women with obesity of 2nd-3rd degrees and pre-eclampsia. The index of insulin resistance HOMA-IR, the level of expression of CD32+CD40+ of circulating endothelial microparticles, which was determined by flow cytophluorimetry, were determined in pregnant women. In women of experimental and control groups the frequency of complications of pregnancy was compared. Results and discussion. In pregnant women with obesity as a result of increased insulin resistance and reducing glucose absorption by tissues there are preconditions for the development of energy insufficiency, as well as an increase in the amount of CD32+CD40+ of circulating endothelial microparticles in the peripheral blood in pregnant women, who had pre-eclampsia, which joined. It confirms the existence of endothelial dysfunction. The deterioration of these indicators progressed as the severity of obesity increases. Comparisons of the frequency of pregnancy complications in experimental and control groups of women indicate that obesity is a risk factor for the emergence of these complications of pregnancy. Conclusion. Thus, the progression of insulin resistance during pregnancy in a group of women with obesity of varying degrees and induced endothelial dysfunction is a pathogenic basis for energy insufficiency and reduction of adaptive mechanisms of pregnant women with obesity, as convincingly indicates an increase in the frequency of obstetric and perinatal complications

Pregnancy-induced changes in β-cell function: what are the key players?

Maternal metabolic adaptations during pregnancy ensure appropriate nutrient supply to the developing fetus. This is facilitated by reductions in maternal peripheral insulin sensitivity, which enables glucose to be available in the maternal circulation for transfer to the fetus for growth. To balance this process and avoid excessive hyperglycaemia and glucose intolerance in the mother during pregnancy, maternal pancreatic β-cells undergo remarkable changes in their function including increasing their proliferation and glucose-stimulated insulin secretion. In this review we examine how placental and maternal hormones work cooperatively to activate several signalling pathways, transcription factors and epigenetic regulators to drive adaptations in β-cell function during pregnancy. We also explore how adverse maternal environmental conditions, including malnutrition, obesity, circadian rhythm disruption and environmental pollutants, may impact the endocrine and molecular mechanisms controlling β-cell adaptations during pregnancy. The available data from human and experimental animal studies highlight the need to better understand how maternal β-cells integrate the various environmental, metabolic and endocrine cues and thereby determine appropriate β-cell adaptation during gestation. In doing so, these studies may identify targetable pathways that could be used to prevent not only the development of pregnancy complications like gestational diabetes that impact maternal and fetal wellbeing, but also more generally the pathogenesis of other metabolic conditions like type 2 diabetes.

CONDITION OF FETURES AND NEWBORNS FROM WOMEN WITH INFERTILITY TREATED WITH ASSISTED REPRODUCTIVE TECHNOLOGIES AND WITH CONCOMITANT INTRAHEPATIC CHOLESTASIS

The aim: Improving the effects of pregnancy on the fetus and newborn through early diagnosis and timely comprehensive therapy of pregnant women with intrahepatic cholestasis. Materials and methods: We have conducted a complex examination of 60 women who got pregnant owing to assisted reproductive technologies, with concomitant intrahepatic cholestasis, and 20 practically healthy women with a physiological course of pregnancy and labor (reference group), aged between 18 and 42. The research did not involve pregnant women with chronic liver diseases, viral hepatitis, skin diseases. Womens who underwent the suggested complex drug therapy with Ursofalc, L-arginine and Omega 3, with peroral administration for 14 days according to the following scheme: Ursofalc – 250 mg once a day, L-arginine – 5 ml 3 times a day, Omega 3 – 1 capsule a day. The complex examination of pregnant women with IHC was conducted before and after treatment. We analyzed the data of anamnesis, carried out anthropometric measurements, clinical biochemical examinations of the women with IHC, including the measurement of the levels of alanine aminotransferase, aspartate aminotransferase, total and direct bilirubin, total and placental alkaline phosphatase, leucine aminopeptidase, 5’-nucleotidase, cholic, deoxycholic and chenodeoxycholic acids as wells as their total level. Results: Almost 40 % of women with intrahepatic cholestasis gave birth to babies with asphyxia, including severe one in 11.1 % of cases, 1/3 of the newborns were premature, 40% had signs of hypotrophy, and 66.7 % experienced a disturbed course of early neonatal adaptation. There was also a higher level of perinatal mortality. The newborns from women who had undergone the suggested complex therapy presented no cases of hypotrophy, prenatal infection or cerebral circulation disorder. Conclusions: Thus, functional hepatic disorders in women with infertility play a certain role in the carrying of pregnancy after ART, in the development of pregnancy complications and adverse consequences for women and their newborns. The conducted research shows that early diagnosis and timely complex therapy of pregnant women with intrahepatic cholestasis makes it possible to influence the pathogenesis of perinatal complications and improve the consequences of pregnancy for the fetus and the newborn.

Care in pregnancies subsequent to stillbirth or perinatal death

Key content Pregnancies following stillbirth have an increased risk of adverse outcome, including a 4.8‐fold increased risk of stillbirth. Risk factors for stillbirth include obesity, smoking, advanced maternal age, fetal growth restriction, hypertension and diabetes. Increased risk of medical problems may result from recurrent placental pathologies or genetic conditions or persistent maternal disease; thus, care for a subsequent pregnancy should commence with investigation of the index stillbirth. Parents also require additional psychological support to navigate mixed emotions, particularly anxiety, about the development of pregnancy complications. Antenatal care in a subsequent pregnancy after stillbirth should ideally be delivered by a multidisciplinary team to provide continuity of physical and psychological care. Learning objectives To improve understanding of the importance of a preconception/early pregnancy appointment and the key information to be covered in such an appointment in a pregnancy after stillbirth. To know what information can be gained from postnatal investigations and the placental histology report and the relationship between this information and a subsequent pregnancy after stillbirth. To be able to describe an example of a model of care used to address medical and psychological needs of parents in subsequent pregnancy. Ethical issues Failing to appreciate the medical and psychological significance of a history of stillbirth may lead to suboptimal antenatal care that does not meet women’s needs. Lack of robust evidence may lead to prescription of medication without clear evidence of benefit.

Iron supplementation during pregnancy: versions and contraversions

Iron deficiency status is one of the most common pregnancy complications in many countries of the world and requires timely diagnosis, prevention and treatment. The article describes the current understanding of etiology, pathogenesis, clinic and diagnosis of clinical manifestations and diagnostics of iron deficiency status during pregnancy. Particular attention is paid to the regulation of iron homeostasis and screening of iron status during pregnancy. According to modern concepts, the initial iron status determines the U-shaped risk curve for pregnancy complications and the effects of iron supplementation. On the one hand, iron deficiency status has a negative impact on the development of pregnancy complications and fetal pathology. When iron deficiency anemia is detected in the first trimester of pregnancy, the association with adverse outcomes is more obvious, but this ratio usually weakens with a detected decrease in hemoglobin in the second or third trimester of pregnancy. On the other hand, several potential mechanisms have now been identified by which excessive iron supplementation or high iron status during pregnancy can have an adverse effect on pregnancy outcomes. The article shows the need for screening of iron status during pregnancy and rational ferroprophylaxis with a personalized approach. Recommendations for choice and use of iron supplements are provided with due account for clinical guidelines and modern evidence-based data. A review of international and domestic sources devoted to the range of problems is made, experience of credible clinical trials is generalized. The issues of dosage, bioavailability, safety of use during pregnancy and pharmaceutical compatibility of iron supplements are considered.

Cyclooxygenase 2 as a Marker of Early Pregnancy Loss in Cytomegalovirus Infection

Background. Increased expression of cyclooxygenase 2 in the placenta plays a significant role in the formation of placental disorders in the pathological course of pregnancy. It was shown that a high level of expression of cyclooxygenase 2 leads to excessive synthesis of prostaglandins, which stimulate the contractile activity of the uterine myometrium and trigger the abortion mechanism. An analysis of modern literature has shown a lack of data proving the involvement of cyclooxygenase 2 in the pathogenesis of early miscarriages in cytomegalovirus infection. Objective. To establish the pathogenetic role of cyclooxygenase 2 in early pregnancy in the course of miscarriage during exacerbation of cytomegalovirus infection. Materials and methods. The study included 86 women with a gestational age of 8–12 weeks, of which 46 women with spontaneous abortion (O03) and exacerbation of cytomegalovirus infection (main group) and 40 women with medical abortion (O04) without cytomegalovirus infection (control group). The material for the study was peripheral blood serum, urine, homogenate of the villous chorion of the placental tissue. The content of cyclooxygenase 2, the level of IgM and IgG antibodies to cytomegalovirus, low-type IgG antibodies to cytomegalovirus (avidity index) were analyzed by enzyme-linked immunosorbent assay; the content of arachidonic acid – by capillary gas-liquid chromatography. Results. During the study, women of the main group found an increase in the concentration of arachidonic acid by 59 % (p &lt; 0.001) and the activity of the lipolytic enzyme cyclooxygenase 2 – by 58 % (p &lt; 0.001) in the placenta villous chorion homogenate. Conclusion. With an exacerbation of cytomegalovirus infection in the homogenate of the villous placenta chorion of pregnant women with spontaneous abortion, an increase in the content of arachidonic acid and the level of cyclooxygenase 2 is observed. An increased level of cyclooxygenase 2 indicates the development of pregnancy complications and can be used as a non-specific marker predictor of pregnancy termination during exacerbation of cytosis.

Prenatal stress and its role in children's pathology: historical aspects and the current status of the question (review of literature)

The article presents an analysis of fundamental data on the problem of stress and its role in the development of stressful diseases. Scientific evidence on the role of stress in childhood pathology indicates the extreme pathogenetic significance of stress. It is proved that stress has three interconnected faces: stress as a link in the adaptation mechanism, stress as a link in the pathogenesis of diseases and adaptation to stressful situations as a natural prevention of stressful diseases. The scientific substantiation of the main evolutionarily determined role of stress as an adaptation link indicates the possibility of acquiring some degree of resistance to stressful situations. Prevention of reducing the excess of stress reactions and reducing the possibility of its transformation into a link in the pathogenesis of diseases limits the complex of mechanisms designated as a stress-limiting system. Important information is the development and coordination of the stress response, which is provided by a complex set of mechanisms of neuroendocrine regulation, united by the concept of “stress-implementing system”. The most common forms of stress are fetal hypoxia, metabolic disturbances, and toxic effects leading to uncontrolled oxidative stress at the cellular and tissue levels with the development of pregnancy complications, intrauterine growth retardation syndrome (IUGR), persistent changes and pathological conditions. As the fetus grows, the flow of oxygen and nutrients from the mother through the placenta increases, which is accompanied by an increased risk of the formation of pathologies of the brain, heart, liver and kidneys with the development of a multi-organ pathology in the subsequent life. It has been proven that oxidative stress combined with stress of malnutrition in the prenatal period increases the risk of endocrinopathies, kidney diseases, and a number of other chronic diseases in the adult state. In practical terms, the negative effects of stress are of particular interest. Early detection of psychosocial and sympathomimetic factors causing stress is the basis for the prevention of childhood pathology.

Bisphenol A and Phthalates in Diet: An Emerging Link with Pregnancy Complications.

Endocrine-disrupting chemicals (EDCs) are exogenous substances that are able to interfere with hormone action, likely contributing to the development of several endocrine and metabolic diseases. Among them, Bisphenol A (BPA) and phthalates contaminate food and water and have been largely studied as obesogenic agents. They might contribute to weight gain, insulin resistance and pancreatic β-cell dysfunction in pregnancy, potentially playing a role in the development of pregnancy complications, such as gestational diabetes mellitus (GDM), and adverse outcomes. Pregnancy and childhood are sensitive windows of susceptibility, and, although with not univocal results, preclinical and clinical studies have suggested that exposure to BPA and phthalates at these stages of life might have an impact on the development of metabolic diseases even many years later. The molecular mechanisms underlying this association are largely unknown, but adipocyte and pancreatic β-cell dysfunction are suspected to be involved. Remarkably, transgenerational damage has been observed, which might be explained by epigenetic changes. Further research is needed to address knowledge gaps and to provide preventive measure to limit health risks connected with exposure to EDCs.