Functional state of the fetoplacental complex in pregnant women with HCV infection

Abstract

Purpose - to study the functional state of the fetoplacental complex (FPC) during pregnancy in women with hepatitis C virus (HCV infection).

Materials and methods. A prospective clinical and statistical analysis of the functional state of the FP during pregnancy in 40 women (main group, MG) with HCV infection was conducted on the basis of the Kyiv City Center of Reproductive and Perinatal Medicine for the period 2020-2021. The control group (CG) consisted of 50 healthy pregnant women. Statistical processing of research results was carried out using standard programs Microsoft Excel 5.0 and Statistica 8.0.

Results. The hormonal status of FPK in MG of pregnant women, starting from the 18t^h week, was characterised by a significant decrease in the secretion of progesterone (PG) (159.3±14.6 nmol/l in MG versus 205.4±4.8 nmol/l in CG; p<0.05) and human chorionic gonadotropin (39.2±4.6 mIU/mL versus 52.8±5.3 mIU/mL, respectively). Estradiol (E2) levels in MG of pregnant women from the 18^th week of pregnancy were significantly lower (26.3±2.7 nmol/l) than in CG of pregnant women (33.7±1.4 nmol/l, p<0.05). A synchronous decrease in the level of PG and E2 was observed in the case of threatened abortion against the background of bloody discharge, which indicated clinical manifestations of placental dysfunction (PD). In MG of pregnant women, the level of placental lactogen (PL) at week 18 was almost the same (80.9±13.2 nmol/l) compared to CG of pregnant women (79.5±7.1 nmol/l; p>0.05). From the 29^th week, the level of E2 in MG of pregnant women is significantly different from CG (25.6±1.3 nmol/l in MG versus 51.2±0.7 nmol/l in CG; p<0.05). The most pronounced difference was the level of estriol (E3) and cortisol (Cr) in blood serum relative to CG in MG of pregnant women, which was manifested by a decrease in the level of E3 (up to 86.4±5.2 nmol/l in MG versus 98.4±2.6 nmol/l in CG; p<0.05) against the background of a simultaneous increase in Cr content (up to 751.1±18.6 nmol/l in MG versus 625.6±18.4 nmol/l in CG; p<0.05). Endocrinological disorders also changed before delivery (39-40 weeks): the E2 level decreased (to 45.4±1.9 nmol/l in MG versus 65.3±0.6 nmol/l in CG; p<0.05), E3 (up to 28.3±2.0 nmol/l versus 57.8±1.8 nmol/l, respectively; p<0.01), PG (up to 499.4±11.6 nmol/l versus 604,2±16.3 nmol/l, respectively; p<0.05) and PL (up to 201.4±12.4 nmol/l versus 63.4±18.8 nmol/l, respectively; p<0.05) and the Cr content increased (up to 812.4±16.7 nmol/l versus 651.6±14.6 nmol/l, respectively; p<0.01).

Conclusions. The functional state of the FPC in pregnant women with HCV infection, on the eve of delivery, is characterized by a high level of premature maturation of the placenta, changes in the volume of amniotic fluid, due to which significant hemodynamic and endocrinological subcompensated disorders appear, but in some cases they are decompensated, which causes disorders from the functional state of the fetus and the high frequency of development of fetal growth retardation syndrome in this group of women.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the paper. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.