The predictive value indicators of first trimester biochemical screening in assessing unfavorable factors of pregnancy course in women with HIV as well as hepatitis B and C

Aim: to find out the predictive value of blood serum biochemical parameters PAPP-A (pregnancy-associated plasma protein A) and β-hCG (beta subunit of human chorionic gonadotropin) in the assessment of unfavorable pregnancy outcomes in women infected by human immunodeficiency virus (HIV) as well as viral hepatitis B (HBV) and C (HCV).

Materials and Methods. A retrospective study of the medical records from 52 women was carried out, including 19 HIV-infected women, 9 women with monoinfection HBV or HCV, 11 pregnant women who were co-infected (HIV/HBV or HIV/HCV) and 13 uninfected women. PAPP-A and β-hCG levels, expressed as MoM (multiple of median), were evaluated in all women.

Results. Our study revealed that only PAPP-A was prognostically significant for developing chronic placental insufficiency in women with HIV infection and co-infection of HIV together hepatitis B and C. None of the parameters examined were significant in women with HBV or HCV monoinfection. PAPP-A and β-hCG in pregnant women without infections were effective in predicting development of chronic placental insufficiency.

Conclusion. PAPP-A can be used as a diagnostic parameter of developing chronic placental insufficiency in pregnant women with monoinfection HIV and co-infection with HIV/HBV or HIV/HCV.

1. HIV/AIDS. World Health Organization, 2021. Available at: https://www.who.int/news-room/fact-sheets/detail/hiv-aids. [Accessed: 15.07.2021].

2. Ladnaya N.N., Pokrovsky V.V., Dementyeva L.A., Sokolova E.V. The epidemic situation of HIV infection in the Russian Federation in 2019. [Epidemicheskaya situaciya po VICh-infekcii v Rossijskoj Federacii v 2019 g]. Epidemiologiya i infekcionnye bolezni. Aktual'nye voprosy. 2020;10(3):17–26. (In Russ.).

3. Hepatitis C and HIV infection: management tactics for patients with co-infection. Clinical protocol for the WHO European Region. [Gepatit S i VICh-infekciya: taktika vedeniya pacientov s sochetannoj infekciej. Klinicheskij protokol dlya Evropejskogo regiona VOZ]. Vsemirnaya organizaciya zdravoohraneniya, 2006. 53 p. (In Russ.). Available at: https://www.euro.who.int/__data/assets/pdf_file/0010/78148/HEP_C_rus.pdf. [Accessed: 15.07.2021].

4. Hepatitis B and HIV infection: management tactics for patients with co-infection. Clinical protocol for the WHO European Region. [Gepatit B i VICh-infekciya: taktika vedeniya pacientov s sochetannoj infekciej. Klinicheskij protokol dlya Evropejskogo regiona VOZ]. Vsemirnaya organizaciya zdravoohraneniya, 2006. 31 p. (In Russ.). Available at: https://www.euro.who.int/__data/assets/pdf_file/0007/91942/HEP_B_rus.pdf. [Accessed: 15.07.2021].

5. Bogomolova I.V. Some aspects of chronic placental dysfunction and perinatal outcomes in HIV-infected pregnant women. [Nekotorye aspekty hronicheskoj fetoplacentarnoj disfunkcii i perinatal'nye iskhody u VICh-inficirovannyh beremennyh]. Zhurnal akusherstva i zhenskih boleznej. 2017;66(S):102–3. (In Russ.).

6. Mohamad J.R., Masihi S., Barati M. et al. Value of pregnancy-associated plasma protein-A for predicting adverse pregnancy outcome. Arch Iran Med. 2019;22(10):584–7. PMID: 31679360.

7. Zamanskaya T.A., Evseeva Z.P., Evseev A.V. Biochemical screening in the first trimester on predicting the complications of pregnancy. [Biohimicheskij skrining v I trimestre pri prognozirovanii oslozhnenij beremennosti]. Rossijskij vestnik akushera-ginekologa. 2008;8(3):71–3. (In Russ.).

8. Kudryavtseva E.V., Kovalev V.V., Baranov I.I. et al. Correlation of prenatal screening indicators of the I trimester with the risk of pregnancy complications. [Vzaimosvyaz' pokazatelej prenatal'nogo skrininga I trimestra s riskom oslozhnenij beremennosti]. Akusherstvo i ginekologiya. Novosti. Mneniya. Obuchenie. 2020;8(1):38–46. (In Russ.). https://doi.org/10.24411/2303-9698-2020-11005.

9. Kasparova A.E., Belotserkovtseva L.D., Kovalenko L.V., Sus L.A. Screenings in early pregnancy: is it possible to predict the formation of cardio-placental insufficiency in preeclampsia. [Skriningi v rannie sroki beremennosti: vozmozhen li prognoz formirovaniya kardio-placentarnoj nedostatochnosti pri preeklampsii]. Vestnik RUDN. Seriya: Medicina. 2011;(S5):123–32. (In Russ.).

10. Kystaubayeva A.S., Tanysheva G.A., Sharipova M.G. et al. The influence of pregnancy-associated plasma proteinA (PAPP-A) on intrauterine growth restriction. [Vliyanie urovnya soderzhaniya associirovannogo s beremennost'yu plazmennogo belka-A (RARR-A) na razvitie narushenij rosta ploda]. Nauka i zdravoohranenie. 2017;(5):55–66. (In Russ.).

11. Nikolaeva Yu.A., Kascheeva T.K., Baranov V.S. The role of biochemical maternal serum markers in prognosis of obstetrical complications. [Znachenie markernyh syvorotochnyh belkov dlya prognoza patologii techeniya beremennosti i sostoyaniya novorozhdennogo]. Zhurnal akusherstva i zhenskih boleznej. 2012;61(3):94–103. (In Russ.).

12. Tsibizova V.I., Govorov I.E., Pervunina T.M. et al. First trimester prenatal screening in multiple pregnancies. Part II: serum proteins PAPP-A and β-hCG as markers of adverse pregnancy outcomes. Obstetrics, Gynecology and Reproduction. 2020;14(1):34–43. (In Russ.). https://doi.org/10.17749/2313-7347.2020.14.1.34-43.

13. Obimbo M.M., Zhou Y., McMaster M.T. et al. Placental structure in preterm birth among HIV-positive versus HIV-negative women in Kenya. J Acquir Immune Defic Syndr. 2019;80(1):94–102. https://doi.org/10.1097/QAI.0000000000001871.

14. Tusupbekova M.M., Kizatova S.T. Peculiarities of pathomorphology in children with perinatal HIV infection and placental lesions in HIV/AIDS in women. [Osobennosti patomorfologii u detej pri perinatal'noj VICh-infekcii i porazheniya placenty pri VICh/SPIDe u zhenshchin]. Teoreticheskaya i eksperimental'naya medicina. 2017;(4):86–93. (In Russ.).

15. Belotserkovtseva L.D., Kovalenko L.V., Tefnants N.A., Kasparova A.E. Morphofunctional changes in placenta in patients with HIV who transmitted viral infection to their child. [Morfofunkcional'nye izmeneniya v placente u pacientok s VICh pri virusnom porazhenii detej infekciej]. Vestnik Novgorodskogo gosudarstvennogo universiteta. 2018;(6):4–8. (In Russ.).

16. Kolobov A.V. The morphogenesis of the human placenta and its morphofunctional state in the pathology of pregnancy. [Morfogenez placenty cheloveka i ee morfofunkcional'noe sostoyanie pri patologii beremennosti]. Vestnik Sankt-Peterburgskogo universiteta. 2015;11(2):5–18. (In Russ).

17. Kurbanov Sh.M., Rakhmatulloeva D.M., Yuldasheva O.E., Bagdasarova N.Kh. Peculiarities of fetoplacenta in pregnant women with viral hepatitis. [Osobennosti fetoplacentarnogo kompleksa u beremennyh s virusnymi gepatitami]. Vestnik Avicenny. 2011;(2):44–8. (In Russ).