DOI: https://doi.org/10.22263/2312-4156.2022.4.52
Ya.I. Bik-Mukhametova1, T.N. Zakharenkova1, N.M. Golubykh1, I.I. Ageeva2
Features of the fetoplacental complex functioning in intrahepatic cholestasis of pregnancy and its obstetric and perinatal complications
1Gomel State Medical University, Gomel, Republic of Belarus
2Gomel Regional Diagnostic Medical Genetic Center with “Marriage and Family” consultation, Gomel, Republic of Belarus
Vestnik VGMU. 2022;21(4):52-58.
Abstract.
Objectives. To determine the features of the synthetic function of the placenta in intrahepatic cholestasis of pregnancy (ICP) and its obstetric and perinatal complications.
Material and methods. The study involved 80 pregnant women. The main group included 54 patients with ICP, and the comparison group consisted of 26 women without clinical and laboratory criteria for cholestasis. In the study groups, the levels of placental proteins and hormones included in the biochemical prenatal screening of the first trimester of pregnancy, the concentration of sex steroids (progesterone, estradiol) in blood serum have been studied. The role of synthetic placental disorders in the development of maternal and perinatal complications in ICP has been determined.
Results. ICP is associated with higher blood progesterone levels in pregnant women (P<0.0001). Significant risk factors for preterm labor (PL) in ICP were: the level of pregnancy-associated protein-A (PAPP-A) ≤ 0.83 MoM (AUC=0.867; p=0.0001) and the level of human chorionic gonadotropin (hCG) ≤ 0.51 MoM (AUC=0.845; p=0.0001) in the blood at the end of the first trimester of pregnancy, the concentration of progesterone in the blood serum of pregnant women with ICP≤1760.1 nmol/l (AUC=0.846; p=0.0001). Predictors of meconium staining of amniotic fluid (MSAF) in women with ICP were: the level of placental growth factor (PlGF) ≤ 0.60 MoM (AUC=0.823; p=0.0001) and PAPP-A value > 1.35 MoM (AUC= 0.751; p=0.025) in the first trimester of pregnancy, the concentration of estradiol in the blood serum of pregnant women with ICP > 27.9 nmol/l (AUC=0.775; p=0.007). A lower concentration of progesterone in the blood (P(U)progesterone=0.012) in patients with ICP, in case of the development of respiratory disorders in their newborns, correlates with premature delivery (rs=-0.552; p=0.047).
Conclusions. In the pathogenesis of ICP, higher levels of progesterone in the blood of pregnant women are important. The development of PL in women with ICP is based on primary placental disorders. MSAF in ICP is associated with ischemia of the placenta against the background of a violation of the secondary wave of trophoblast invasion and leads to the activation of compensatory hormonal mechanisms that improve blood supply in it.
Keywords: fetoplacental complex, pregnancy-associated protein A, human chorionic gonadotropin, placental growth factor, sex steroids, preterm labor, meconium staining of amniotic fluid.
Acknowledgements: The authors are grateful in advance to the editors and reviewers for the work done and look forward to fruitful cooperation.
Funding: The work was carried out at the expense of the budget allocation for the maintenance of higher educational institutions within the framework of the research work “To develop and introduce into clinical practice a method for the medical prevention of obstetric, perinatal and infantile complications in intrahepatic cholestasis of pregnant women” (State Registration No. 20200378 dated 03/25/2020).
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Information about authors:
Ya.I. Bik-Mukhametova – lecturer of the Chair of Obstetrics and Gynecology with the course of the Faculty for Advanced Training & Retraining, Gomel State Medical University, https://orcid.org/0000-0002-6134-4275
E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Yanina I. Bik-Mukhametova;
T.N. Zakharenkova – Candidate of Medical Sciences, associate professor, head of the Chair of Obstetrics and Gynecology with the course of the Faculty for Advanced Training & Retraining, Gomel State Medical University, https://orcid.org/0000-0002-0718-8881
N.M. Golubykh – research officer of the Research Laboratory, Gomel State Medical University, https://orcid.org/0000-0002-3335-7159
I.I. Ageeva – head of Clinical Diagnostic Laboratory, Gomel Regional Diagnostic Medical Genetic Center with ‘‘Marriage and Family’’ consultation.
