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Obstetrics, Gynecology and Reproduction

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ORIGINAL ARTICLE 

20
Abstract

Aim: to study the activity of the hypoxia marker HIF-1α (hypoxia-inducible factor-1α) in pregnant women with phlebopathy.

Materials and Methods. We examined 70 women with phlebopathy in the dynamics of pregnancy. The main group consisted of 30 patients whose newborns had signs of hypoxia; the control group consisted of 40 women with healthy children. All women underwent ultrasound examinations of the veins of the lower extremities and pelvis with an assessment of vascular patency, the condition of the venous valves, and the phenomenon of platelet sludge. The expression of the HIF-1α transcription factor at 18–20 and 36 weeks was performed by real-time PCR.

Results. Disorder of veins functional state was found in all pregnant women of the main group, which was accompanied by the formation of platelet sludge of varying degrees in the area of the venous valves in the majority, signs of endothelial dysfunction and venous hypoxia – an increase in the expression of the hypoxia gene HIF1-α by 2.18 times. In the women of the control group the indicators were not violated.

Conclusion. The transcription factor HIF1-α can be considered a marker of unfavorable perinatal outcomes in pregnant women with signs of phlebopathy.

156
Abstract

Aim: to identify the risk factors for gestational diabetes mellitus (GDМ) and predictors of perinatal lesions of central nervous system (CNS) in combination of GDМ and maternal obesity.

Materials and Methods. А retrospective observational case-control uncombined study was conducted to determine GDМ risk factors and their effect on perinatal pathology in 250  women divided into 2 groups. The main group included 150 pregnant women diagnosed with GDМ, the control group – 100 pregnant women without carbohydrate metabolism disorders. An assessment of hereditary, obstetric and gynecological history, somatic health was carried out. Patients of the main group were divided into smaller groups: 1А (n = 77) – mothers whose newborns postnatal had adverse perinatal outcomes associated with the influence of maternal hyperglycemia and 1В (n = 73) – mothers whose newborns were born healthy. CHAID method (Chi Squared Automatic Interaction Detection) was used to create an algorithm for predicting adverse perinatal outcomes in GDМ. Аt the second stage, a single-center prospective observational non-combined cohort study was conducted to assess the effect of maternal hyperglycemia on the formation of perinatal lesions of CNS. The concentration of neuron-specific enolase (NSE) was determined before the labor in the amniotic fluid of full-term fetuses in the group of pregnant women without carbohydrate metabolism disorders (n = 42) and in the group of pregnant women with GDM (n = 33).

Results. Obesity, late reproductive age, family history of diabetes mellitus type 2 (DM-2), abortions, early reproductive losses, large for gestational age fetuses in history are the main risk factors for GDM developing. An algorithm was developed that allowed the prediction of the risk of the newborn perinatal pathology in the mother with GDM. The concentration of NSE in the amniotic fluid of full-term fetuses before the onset of labor increases with a combination of GSD and obesity (5.56 [3.37–6.24] by 1.68 times compared to the concentration in pregnant women with normal weight without carbohydrate metabolism disorders (3.29 [1.49–4.89]) (p = 0,006). 

Conclusion. Pregnant women with obesity and a family history of DM-2 have the highest possibility of perinatal complications. Increasing the concentration of NSE in amniotic  fluid in patients with GDМ confirms damage to the fetal CNS in the antenatal  period. The maximum NSE level was determined in the combination of GSМ and obesity 



ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)