Mathematical modeling of pregnancy loss with normal embryo karyotype in the first trimester
https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.239
Abstract
Introduction. The risk of pregnancy loss in the first trimester comprises 12.5-18.7 %. It is timely and relevant to develop methods for predicting miscarriage.
Aim: to develop a predictive model for assessing a risk of miscarriage in case of normal embryo karyotype.
Materials and Methods. The single-center cohort retrospective comparative study included 52 women with miscarriage at 6-12 weeks of gestation with normal embryo karyotype (main group) and 126 women with physiologically proceeding pregnancies and favorable perinatal outcomes (control group). All patients underwent general clinical and laboratory examination, analysis of genetic polymorphisms (FGBG -455A, F2 G20210A, F5 G1691A, F7 G10976A, F13 G103A, PAI-1 -675 5G/4G, ITGA2 C708T, ITGB3 T176C, MTHFR C677T, MTHFR A1298C, MTR A2756G, MTRR A66G, NOS3 T-786C, NOS3 C894T), spouse examination.
Results. The factors associated with the loss of pregnancy turned out to be presented by a history of infertility, patient adenomyosis, a higher platelet count, as well as abnormal partner spermogram. Significant differences were obtained between the studied groups in the frequency of concurrent polymorphisms PAI-1 -675 5G/4G, MTHFR C677T, MTRR A66G, NOS3 G894T. Based on the identified patterns, a mathematical model has been developed allowing to determine the high risk of pregnancy loss in the first trimester (86.0 % efficiency).
Conclusion. A comprehensive assessment of clinical and anamnestic indicators, molecular genetic parameters, spouse-related health indicators, it is possible to determine risk groups of pregnancy loss in case a normal embryo karyotype. Timely prediction provides the basis for optimizing preconception care and conducting timely prevention of miscarriage.
About the Authors
N. N. Potapov
City Clinical Hospital № 40
Russian Federation
Russian Federation
Nikolay N. Potapov - MD, Head of the Department of Gynecology № 2, City Clinical Hospital № 40.
189 Volgogradskaya Str., Ekaterinburg 620102.
E. V. Kudryavtseva
Ural State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Elena V. Kudryavtseva - MD, Dr Sci Med, Associate Professor, Department of Obstetrics and Gynecology, Ural State Medical University.
3 Repin Str., Ekaterinburg 620028.
V. V. Kovalev
Ural State Medical University, Health Ministry of Russian Federation
Russian Federation
Russian Federation
Vladislav V. Kovalev - MD, Dr Sci Med, Professor, Head of the Department of Obstetrics and Gynecology, Transfusiology, Ural State Medical University.
3 Repin Str., Ekaterinburg 620028.
References
1. Quenby S., Gallos I.D., Dhillon-Smith R.K. et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet. 2021;397(10285):1658-67. https://doi.org/10.1016/S0140-6736(21)00682-6.
2. Miscarriage: worldwide reform of care is needed. Lancet. 2021;397(10285):1597. https://doi.org/10.1016/S0140-6736(21)00954-5.
3. Coomarasamy A., Gallos I.D., Papadopoulou A. et al. Sporadic miscarriage: evidence to provide effective care. Lancet. 2021;397(10285):1668-74. https://doi.org/10.1016/S0140-6736(21)00683-8.
4. Kudryavtseva E.V., Kovalev V.V., Baranov I.I. et al. The role of fetal chromosomal aberrations in the genesis of reccurent and sporadic miscarriage. [Rol' hromosomnyh aberracij embriona v geneze privychnogo i sporadicheskogo nevynashivaniya beremennosti]. Voprosy ginekologii, akusherstva i perinatologii. 2021;20(1):34-9. (In Russ.). https://doi.org/10.20953/1726-1678-2021-1-34-39.
5. Kudryavtseva E.V., Kovalev V.V., Kanivets I.V., Korostelev S.A. Modern abilities to detect chromosomal abnormalities in the abortive material. [Sovremennye vozmozhnosti vyyavleniya hromosomnyh anomalij v abortivnom materiale. Ural'skij medicinskij zhurnal. 2016;(11):5-8. (In Russ.).
6. Kacprzak M., Chrzanowska M., Skoczylas B. et al. Genetic causes of recurrent miscarriages. Ginekol Pol. 2016;87(10):722-6. https://doi.org/10.5603/GP.2016.0075.
7. Sahoo T., Dzidic N., Strecker M.N. et al. Comprehensive genetic analysis of pregnancy loss by chromosomal microarrays: outcomes, benefits, and challenges. Genet Med. 2017;19(1):83-9. https://doi.org/10.1038/gim.2016.69.
8. Coomarasamy A., Devall A.J., Brosens J.J. et al. Micronized vaginal progesterone to prevent miscarriage: a critical evaluation of randomized evidence. Am J Obstet Gynecol. 2020;223(2):167-76. https://doi.org/10.1016/j.ajog.2019.12.006.
9. ESHRE Guideline Group on RPL; Atik R.B., Christiansen O.B., Elson J. et al. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open. 2018;(2):hoy004. https://doi.org/10.1093/hropen/hoy004.
10. Adamyan L.V., Artymuk N.V., Belokrinitskaya T.E. and other Miscarriage in early pregnancy: diagnosis and management tactics. [Vykidysh v rannie sroki beremennosti: diagnostika i taktika vedeniya]. Problemy reprodukcii. 2018;24(S6):338-57. (In Russ.).
11. Dobrokhotova Yu.E., Mandrykina Zh.A., Narimanova M.R. Missed abortion: reasons and possibilities for rehabilitation. [Nesostoyavshijsya vykidysh. Prichiny i vozmozhnosti reabilitacii]. Rossijskij vestnik akushera-ginekologa. 2016;16(4):85-90. (In Russ.). https://doi.org/10/17166/rosakush201616485-90.
12. Andreeva M.D., Kapanadze D.L., Samburova N.V. Obstetric and perinatal outcomes in patients with a history of fetal loss syndrome, genetic and acquired forms of thrombophilia. Obstetrics, Gynecology and Reproduction. 2014;8(4):54-5. (In Russ.).
13. Makatsariya A.D., Khizroeva J.Kh., Bitsadze V.O., Akinshina S.V. Pregnancy and homozygotic and combined forms of thromophilia at patients with thrombotic and obstetric burdened anamnesis. [Beremennost' i gomozigotnye i sochetannye formy tromofilii u pacientok s tromboticheskim i akusherskim otyagoshchyonnym anamnezom]. Tromboz, gemostaz i reologiya. 2016;(S3):269-70. (In Russ.).
14. Kamali M., Hantoushzadeh S., Borna S. et al. Association between thrombophilic genes polymorphisms and recurrent pregnancy loss susceptibility in the Iranian population: a systematic review and metaanalysis. Iran Biomed J. 2018;22(2):78-89. https://doi.org/10.22034/ibj.22.2.78.
15. Mehandjiev T.R., Tenno N.M., Nakura Y. et al. Impact of maternal methylenetetrahydrofolate reductase C677T polymorphism on intervillous and decidual pathology with pregnancy loss. J Obstet Gynaecol Res. 2019;45(1):78-85. https://doi.org/10.1111/jog.13798.
16. Ruixue W., Hongli Z., Zhihong Z. et al. The impact of semen quality, occupational exposure to environmental factors and lifestyle on recurrent pregnancy loss. J Assist Reprod Genet. 2013;30(11):1513-8. https://doi.org/10.1007/s10815-013-0091-1.
17. Anifandis G., Bounartzi T., Messini C.I. et al. The impact of cigarette smoking and alcohol consumption on sperm parameters and sperm DNA fragmentation (SDF) measured by Halosperm(®). Arch Gynecol Obstet. 2014;290(4):777-82. https://doi.org/10.1007/s00404-014-3281-x.
18. Pacey A.A. Environmental and lifestyle factors associated with sperm DNA damage. Hum Fertil (Camb). 2010;13(4):189-93. https://doi.org/10.3109/14647273.2010.531883.
19. Kovalev V.V., Kudryavtseva E.V. Molecular genetic deviations and obstetric pathology. [Molekulyarno-geneticheskie deviacii i akusherskaya patologiya]. Akusherstvo i ginekologiya. 2020;(1):28-31. (In Russ.) https://doi.org/10.18565/aig.2020.1.26-32.
20. Trifonova E.A., Swarovskaya M.G., Ganzha O.A. et al. The interaction effect of angiogenesis and endothelial dysfunction-related gene variants increases the susceptibility of recurrent pregnancy loss. J Assist Reprod Genet. 2019;36(4):717-26. https://doi.org/10.1007/s10815-019-01403-2.
21. Zhao X., Li Q., Yu F. et al. Gene polymorphism associated with endothelial nitric oxide synthase (4VNTR, G894T, C786T) and unexplained recurrent spontaneous abortion risk: a meta-analysis. Medicine (Baltimore). 2019;98(4):e14175. https://doi.org/10.1097/MD.0000000000014175.
22. Cao X., Cui Y., Zhang X. et al. The correlation of sperm morphology with unexplained recurrent spontaneous abortion: a systematic review and meta-analysis. Oncotarget. 2017;8(33):55646-56. https://doi.org/10.18632/oncotarget.17233.
23. Carlini T., Paoli D., Pelloni M. et al. Sperm DNA fragmentation in Italian couples with recurrent pregnancy loss. Reprod Biomed Online. 2017;34(1):58-65. https://doi.org/10.1016/j.rbmo.2016.09.014.
24. Coughlan C., Clarke H., Cutting R. et al. Sperm DNA fragmentation, recurrent implantation failure and recurrent miscarriage. Asian J Androl. 2015;17(4):681-5. https://doi.org/10.4103/1008-682X.144946.
Review
For citations:
Potapov N.N., Kudryavtseva E.V., Kovalev V.V. Mathematical modeling of pregnancy loss with normal embryo karyotype in the first trimester. Obstetrics, Gynecology and Reproduction. 2021;15(4):379-389. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2021.239
Views: 546
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 
