PATHOGENETIC JUSTIFICATION OF THE ALGORITHM OF PREPARATION FOR PREGNANCY OF FUTURE PARENTS WITH HABITUAL MISCARRIAGE IN ANAMNESIS OF WOMEN
DOI:
https://doi.org/10.11603/24116-4944.2021.1.12366Keywords:
preconception preparation, habitual miscarriage, folate cycle genesAbstract
The aim of the study – to reduce the frequency and severity of gestational complications in women with recurrent miscarriage, by carrying out personalized preconception preparation.
Materials and Methods. 135 people of reproductive age were examined. 45 women (group Aw) suffering from recurrent miscarriage, 45 of them men (group Am) who underwent the proposed preconception preparation, and 45 women (group B) with a history of recurrent miscarriage. An algorithm for complex personalized preconception preparation was developed and proposed. All patients underwent a generally recognized examination in accordance with the current clinical protocols approved by the orders of the Ministry of Health of Ukraine.
Results and Discussion. Concomitant somatic pathology in women was up to 73.3 %. Almost 100 % of women had a history of vaginal infections, cervical inflammatory processes (endocervicitis, cervicitis) – 60.0 % and 62.2 %, uterine leiomyoma – 28.9 and 26.7 %, endometriosis – 11.1 and 13.3 %, chronic endometritis – 8.9 and 11.1 %, chronic salpingo-oophoritis – 13.3 and 15.6 %, menstrual dysfunction – 44.4 and 46.7 % of the examined groups A and B. The pathology of spermatogenesis was found in men in 31.1 %, of the urogenital tract – in 55.6 % of the examined. Homozygous MTHFR polymorphism was found in 32.2 % and heterozygous – in 43.3 % in women of groups A and B. The combined polymorphism of the folate cycle genes MTHFR 1298 A/C, MTHFR 677 C/T, MTR 2756 A>G, MTRR 66 A>G in the surveyed population ranged from 66.7 % to 80.0 % of observations. The frequency of the syndrome of the threat of early miscarriage was significantly reduced by 2.1 times, chorionic detachment by 3.6 times, and late miscarriage by 3.1 times in the group of women who underwent the proposed complex staged pre-conceptual training with the biological parents of children.
Conclusions. It is necessary to examine and prepare future parents according to a personalized algorithm 3–4 months before fertilization, including, according to the results of a hereditary predisposition to violations of the folate cycle with the prescription of Metafolin in physiological doses in case of recurrent miscarriage.
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