DISORDERS OF SLEEP AND CHANGES OF CONCENTRATIONS OF MELATONIN IN SALIVA IN PREGNANT WOMEN WITH PLACENTAL INSUFFICIENCY, REALIZED AS INTRAUTERINE FETAL GROWTH RESTRICTION
DOI:
https://doi.org/10.11603/24116-4944.2019.1.10182Keywords:
sleep disorders, placenta, melatonin, intrauterine fetal growth restrictionAbstract
The aim of the study – to learn the reasons of appearance, terms of manifestation and types of the sleep disorders, as well as changes of the concentrations of melatonin in saliva of pregnant women with intrauterine growth restriction of fetus.
Materials and Methods. 80 pregnant women with placental insufficiency (PI), manifesting as intrauterine fetal growth restriction (IUGR) of II-III degree in the 3rd pregnancy trimester (study group) and 30 women with normal clinical flow of pregnancy (control group) were questioned. They were asked about pregnancy term when the complaints of the sleep disorders were firstly expressed, as well as about types of the sleep disorders and their frequency (in times per week). The concentrations of melatonin in saliva of 22 pregnant women from the group with PI were studied. 10 women with uncomplicated pregnancy were included in the control group. 14 healthy non-pregnant women were also examined in the same way. The levels of melatonin in saliva were studied at 3 am and 6 am using diagnostical kit Melatonin ELISA produced by IBL (Germany). The statistical calculations were performed by Mann-Whitney criteria for small samples using MedCalc software.
Results and Discussion. Questioning showed that pregnant women with IUGR in 86 % cases experience the sleep disorders starting from pregnancy term 12–22 weeks (healthy pregnant women – mostly after 30 weeks, 57 % cases), more commonly wake up 2 or more times per night (71 % of positive answers, in control group – 23 %), and 3 or more times per week (78 % of positive answers, in control group – 17 %). In pregnant women with PI realized as IUGR II-III, concentrations of melatonin in saliva were significantly lowered, comparing to healthy pregnant women, at 3 am (group with PI 1.75 ng/ml, 95 % confidence interval for mediana 1.30–2.50 ng/ml, in the group of healthy pregnant women 7.55 ng/ml, 95 % confidence interval for mediana 2.35–8.91 ng/ml), and at 6 am (group with PI 1.50 ng/ml, 95 % confidence interval for mediana 1.20–2.51 ng/ml, in the group of healthy pregnant women 4.35 ng/ml, 95 % confidence interval for mediana 1.49–7.66 ng/ml). In pregnant women with uncomplicated pregnancy the concentration of melatonin, sampled at 3 am, was considered as the highest among compared groups, f.e. it was significantly higher than in non-pregnant patients (in the group of healthy pregnant women melatonin concentration in saliva was 7.55 ng/ml, 95 % confidence interval for mediana 2.35–8.91 ng/ml, and in pregnant women with non-complicated pregnancy – 2.50 ng/ml, 95 % confidence interval 1.39–2.81 ng/ml).
Conclusions. 1. Sleep disorders in pregnant women with IUGR appear earlier and seem to be more expressed than in pregnant women with normal fetal growth. 2. Expression of the complaints of insomnia, in our opinion, might be considered as an early diagnostic sign of forming of placental insufficiency, which is later realized as IUGR. 3. In pregnant women with PI, realized as IUGR of the II-III degree, concentrations of melatonin in saliva are significantly lower at 3 am and 6 am, comparing to women with non-complicated pregnancy.
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