Maternal factors of preconceptual and early gestation periods in women with high prenatal diagnostic risks

Abstract

Objective — evaluate maternal factors in preconception and early gestation periods in women with a high risk of prenatal diagnosis.

Methods and patients. Features of the development of preconception and early gestation periods were studied, including the first prenatal screening (PS), in 443 women with singleton pregnancy. Women were divided into 2 clinical groups: group 1 (n = 235) with a high risk (HR) of complications; subgroups: 1A (n = 69) — fetal chromosomal abnormalities (after exclusion confirmed cases); 1B (n = 66) — the development of preeclampsia; 1C (n = 48) — fetal growth restriction; 1D (n = 52) — preterm birth (PB). 2nd control group (n = 208) — women with low risk of complications.

Results. A high PS risk in the 1st group, especially in subgroups 1A, 1B, were in patients with hypertonic disease of 1-2 degrees (p < 0.05). Chronic kidney disease was leading in 1A, 1C (p < 0.05). Varicose veins of the lower extremities in the 1st group prevailed in the 1A, 1B, 1C (p < 0.05). A history of ovarian tumors and uterine myoma during pregnancy prevailed in 1A, 1B, cycle dysfunction in 1B, 1D (p < 0.05). GR was observed in nulliparous women with a history of miscarriages in 1B, 1C, 1D and artificial abortions in 1A (p < 0.05). PB in the anamnesis were significantly increased in the 1st gr. (p < 0.001). In the 1st trimester, the threatened miscarriage, bleeding and progesterone were frequent in the 1st group (p < 0.05).

Conclusion. Based on the obtain results a high risk of PS calculated according to the Astraia program using standard markers was noted in patients with somatic pathology, ovarian tumors, miscarriages, medical abortions and PB in the anamnesis, myoma during pregnancy, threatened miscarriage, bleeding, progesterone intake during 1st trimester. These factors should be considered when preparing for pregnancy.

Keywords

preconception period / maternal risk factors / prenatal screening / chromosomal abnormalities / threatened abortion

References

[1] Cuckle H., Platt L.D., Thornburg L.L., Bromley B., Fuchs K., Abuhamad A. et al. Nuchal Translucency Quality Review Program of the Perinatal Quality Foundation. Nuchal Translucency Quality Review (NTQR) program: first one and half million results. Ultrasound Obstet. Gynecol. 2015;45(2):199‐204. doi: https://doi.org/10.1002/uog.13390

[2] Sung K.U., Roh J.A., Eoh K.J., Kim E.H. Maternal serum placental growth factor and pregnancy-associated plasma protein A measured in the first trimester as parameters of subsequent pre-eclampsia and small-for-gestational-age infants: A prospective observational study. Obstet. Gynecol. Sci. 2017;60(2):154‐62. doi: https://doi.org/10.5468/ogs.2017.60.2.154

[3] Livrinova V., Petrov I., Samardziski I., Jovanovska V., Boshku A.A., Todorovska I. et al. Clinical importance of low level of PAPP-A in first trimester of pregnancy - an obstetrical dilemma in chromosomally normal fetus. Open Access Maced J. Med. Sci. 2019;7(9):1475‐9. doi: https://doi.org/10.3889/oamjms.2019.384

[4] O’Gorman N., Wright D., Syngelaki A., Akolekar R., Wright A., Poon L.C., Nicolaides K.H. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation. Am. J. Obstet. Gynecol. 2016;214(1):103.e1‐103.e12. doi: https://doi.org/10.1016/j.ajog.2015.08.034

[5] Preconception care: Maximizing the gains for maternal and child health. Geneva: World Health Organization (WHO); 2013.

[6] Dean S.V., Imam A.M., Lassi Z.S., Bhutta Z.A. Importance of intervening in the preconception period to impact pregnancy outcomes. Nestle Nutr. Inst. Workshop Ser. 2013;74:63‐73. doi: https://doi.org/10.1159/000348402

[7] Dean S.V., Lassi Z.S., Imam A.M., Bhutta Z.A. Preconception care: closing the gap in the continuum of care to accelerate improvements in maternal, newborn and child health. Reprod. Health. 2014; 11(Suppl. 3):S1. doi: https://doi.org/10.1186/1742-4755-11-S3-S1

[8] Aylamazyan A.K., Kulakov V.I., Radzinskiy V.E., Savel’yeva G.M., eds. Obstetrics: National guidance. Moscow: GEOTAR-Media; 2007. (In Russ.).

[9] Айламазян А.К., Кулаков В.И., Радзинский В.Е., Савельева Г.М., ред. Акушерство: Национальное руководство. М.: ГЭОТАР-Медиа; 2007.

[10] Radzinskiy V.E. Obstetric aggression. [Akusherskaya agressiya]. Moscow: StatusPraesens; 2011. (In Russ.)

[11] Радзинский В.Е. Акушерская агрессия. М.: StatusPraesens; 2011.

[12] Usta I.M., Zoorob D., Abu-Musa A., Naassan G., Nassar A.H. Obstetric outcome of teenage pregnancies compared with adult pregnancies. Acta Obstet. Gynecol. Scand. 2008;87(2):178‐83. doi: https://doi.org/10.1080/00016340701803282

[13] Ciancimino L., Laganà A.S., Chiofalo B., Granese R., Grasso R., Triolo O. Would it be too late? A retrospective case-control analysis to evaluate maternal-fetal outcomes in advanced maternal age. Arch. Gynecol. Obstet. 2014;290(6):1109‐14. doi: https://doi.org/10.1007/s00404-014-3367-5

[14] Langley S. A nutrition screening form for female infertility patients. Can. J. Diet. Pract. Res. 2014;75(4):195‐201. doi: https://doi.org/10.3148/cjdpr-2014-024

[15] Committee of experts of the Russian Cardiological Society. Diagnostics and treatment of cardiovascular diseases during pregnancy: Russian recommendations. Rossiyskiy kardiologicheskiy zhurnal. 2013;(4s1):4-40. (In Russ.)

[16] Комитет экспертов Российского кардиологического общества. Диагностика и лечение сердечно-сосудистых заболеваний при беременности: Российские рекомендации. Российский кардиологический журнал. 2013;(4 Прил. 1):4-40.

[17] Tikhomirov A.L., Sarsaniya S.I. Iron deficiency anemia in women: solutions to the problem. Russkiy meditsinskiy zhurnal. Mat’ i ditya. 2020;3(1):44-50. (In Russ.) doi: https://doi.org/10.32364/2618-8430-2020-3-1-44-50

[18] Тихомиров А.Л., Сарсания С.И. Проблема железодефицитной анемии у женщин: пути решения. Рус. мед. журн. Мать и дитя. 2020;1:44-50.

[19] Stuklov N.I. Iron-deficiency anemia in the practice of a gynecologist. Algorithms for diagnosis, prevention, and treatment. Akusherstvo i ginekologiya. 2016;7:99-104. (In Russ.) doi: http://doi.org/10.18565/aig.2016.7.99-104

[20] Стуклов Н.И. Железодефицитная анемия в практике гинеколога. Алгоритмы диагностики, профилактики и лечения. Акуш. и гин. 2016;7:99-104. doi: http://doi.org/10.18565/aig.2016.7.99-104

[21] Dedov I.I., Krasnopol’skiy V.I., Sukhikh G.T. Russian National Consensus Statement on gestational diabetes: diagnostics, treatment and postnatal care. Diabetes Mellitus. 2012;(4):4-10. (In Russ.)

[22] Дедов И.И., Краснопольский В.И., Сухих Г.Т. Российский национальный консенсус «Гестационный сахарный диабет: диагностика, лечение, послеродовое наблюдение». Сахарный диабет. 2012;(4):4-10.

[23] Stagnaro-Green A., Abalovich M., Alexander E., Azizi F., Mestman J., Negro R., et al. American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21(10):1081‐25. doi: https://doi.org/10.1089/thy.2011.0087

[24] Stagnaro-Green A., Abalovich M., Alexander E., Azizi F., Mestman J., Negro R., et al. American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011; 21(10):1081‐25. doi: https://doi.org/10.1089/thy.2011.0087

[25] Lassi Z.S., Imam A.M., Dean S.V., Bhutta Z.A. Preconception care: screening and management of chronic disease and promoting psychological health. Reprod. Health. 2014;11(Suppl 3):S3-S5. doi: https://doi.org/10.1186/1742-4755-11-S3-S5

[26] Lassi Z.S., Imam A.M., Dean S.V., Bhutta Z.A. Preconception care: screening and management of chronic disease and promoting psychological health. Reprod. Health. 2014; 11 (Suppl 3): S3-S5. doi: https://doi.org/10.1186/1742-4755-11-S3-S5

[27] Dedov I.I., Mel’nichenko G.A., eds. Endocrinology: Russian clinical recommendations. [Endokrinologiya: Rossiyskiye klinicheskiye rekomendatsii]. Moscow: GEOTAR-Media; 2016. (In Russ.)

[28] Дедов И.И., Мельниченко Г.А., ред. Эндокринология: Российские клинические рекомендации. М.: ГЭОТАР-Медиа; 2016.

[29] Platonova N.M. Hypothyroidism and pregnancy. Poliklinika. 2014; 2:1-5. (In Russ.).

[30] Платонова Н.М. Гипотиреоз и беременность. Поликлиника. 2014;2:1-5.

[31] Farkash E., Weintraub A.Y., Sergienko R., Wiznitzer A., Zlotnik A., Sheiner E. Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes. Eur. J. Obstet. Gynecol. Reprod. Biol. 2012;162(1):24‐7. doi: https://doi.org/10.1016/j.ejogrb.2012.01.024

[32] Matuszkiewicz-Rowińska J., Małyszko J., Wieliczko M. Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems. Arch. Med. Sci. 2015;11(1):67‐77. doi: https://doi.org/10.5114/aoms.2013.39202

[33] Christiansen O.B. Recurrent pregnancy loss. Causes, controversies and treatment. New-York: CRC Press by Taylor & Francis Group; 2014:1-16.

[34] About improvement of the organization of prenatal (prenatal) diagnostics of disorders of development of the fetus/child: Order Of the Department of health of Moscow of 14.06.2013 No. 600. [O sovershenstvovanii organizatsii prenatal’noy (dorodovoy) diagnostiki narusheniy razvitiya ploda/rebenka: Prikaz Departamenta zdravookhraneniya g. Moskvy ot 14.06.2013 № 600]. Moscow; 2013. (In Russ.)

[35] О совершенствовании организации пренатальной (дородовой) диагностики нарушений развития плода/ребенка: Приказ Департамента здравоохранения г. Москвы от 14.06.2013 № 600. М.; 2013.

[36] About the approval of the Order of rendering medical care in the profile “obstetrics and gynecology (except for the use of assisted reproductive technologies)”: Order of the Ministry of Health of the Russian Federation of November 1, 2012 No. 572n. [Ob utverzhdenii Poryadka okazaniya meditsinskoy pomoshchi po profilyu “akusherstvo i ginekologiya (za isklyucheniem ispol’zovaniya vspomogatel’nykh reproduktivnykh tekhnologiy)”: Prikaz Ministerstva zdravookhraneniya Rossiyskoy Federatsii ot 1 noyabrya 2012 g. № 572n]. Moscow: 2012 (In Russ.)

[37] Об утверждении Порядка оказания медицинской помощи по профилю «акушерство и гинекология (за исключением использования вспомогательных репродуктивных технологий): Приказ Минздрава РФ от 1 ноября 2012 г. № 572н. М.; 2012.

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