PREDICTING THE RISK OF OBSTETRIC COMPLICATIONS IN PREGNANT WOMEN WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
DOI:
https://doi.org/10.11603/24116-4944.2024.1.14698Keywords:
pregnancy, chronic obstructive pulmonary disease, obstetric complications, preventive therapy, L-arginineAbstract
The aim of the study - to develop a program for the preventive treatment of obstetric complications and diagnosis in pregnant women with chronic obstructive pulmonary disease.
Materials and Methods. A prospective cohort randomized study was carried out with 163 pregnant females, which were split into 3 groups. The main group included 54 pregnant women with COPD according to bronchial obstruction stage. The comparison group included 77 pregnant women with COPD with I and II degree of bronchial obstruction. The control group included 32 pregnant females without pathology. Pregnant women in the main group received, in addition to standard protocol treatment, an oral solution of L-arginine and a vitamins and mineral complex according to the preventive therapy of obstetric complications. The statistical analysis of the results was performed using Statistica 10.0 (StatSoft, Inc., USA) and Microsoft Office Excel 2010.
Results and Discussion. When analyzing the course of pregnancy in women with COPD compared with the control group of healthy pregnant women, a significantly higher incidence of obstetric and perinatal complications was noted, which depended on the degree of bronchial obstruction. Thus, placental dysfunction occurred 2.3 times more often in the IIA and 3.2 times more often in the IIB subgroup compared with the control group, intrauterine growth restriction - 11.6% in the IIA and 23.5% in the IIB subgroup, fetal distress during pregnancy (2.3% in the IIA and 8.8% in the IIB subgroup, respectively), anemia (20.9% and 32.4%, respectively). Also, in the subgroup with moderate bronchial obstruction the threat of preterm labor was detected in 17.6% of pregnant women (3.1% in the control group), and in 11.8% preterm labor happened. In the subgroup with a mild degree of bronchial obstruction the threat of preterm labor was observed in 9.3%. Disturbances in the redox system, which contributes to a systemic inflammatory response and endothelial dysfunction can cause these obstetric complications development. Clinical testing of the proposed drug complex as a preventive therapy for obstetric complications in pregnant women with COPD showed that under the influence of such treatment, obstetric and perinatal complications develop significantly less often (p˂0.05). Thus, in the main group of pregnant women under the influence of treatment the incidence of preeclampsia decreased by 2.3 times, the threat of early and late miscarriage - by 2.6 and 2.3 times, respectively, and preterm labor - by 2.3 times, placental dysfunction - by 2.5 times, that was accompanied by a significant decrease in the incidence of IUGR by 3 times, anemia by 1.8 times compared with the group of pregnant women who received basic protocol therapy (p˂0.05).
Conclusions. In pregnant women with COPD, clinical testing of the recommended drug complex for prevention of pregnant complications significantly improved the indexes of lipid peroxidation/antioxidant protection, endothelial function and systemic inflammation, which reduced the incidence of preeclampsia, the threat of early and late miscarriage, preterm labor, anemia, IUGR and placental dysfunction.
References
Agustí, A., Celli, B.R., Criner G.J., Halpin, D., Anzueto, A., Barnes, P., Bourbeau, J., Han, M.K., Martinez, F.J., Montes de Oca, M., Mortimer, K., Papi, A., Pavord, I., Roche, N., Salvi, S., Sin, D.D., Singh, D., Stockley, R., López Varela, M.V., Wedzicha, J.A., & Vogelmeier, C.F. (2023). Global Initiative for Chronic Obstructive Lung Disease 2023 Report. GOLD Executive Summary. Eur Respir J. 61(4):1, 2300239. DOI: 10.1183/13993003.00239-2023. PMID: 36858443; PMCID: PMC10066569.
Celli, B.R., Decramer, M., Wedzicha, J.A., Wilson, K.C., Agustí, A., Criner, G.J., MacNee, W., Make, B.J., Rennard, S.I., Stockley, R.A., Vogelmeier, C., Anzueto, A., Au, D.H., Barnes, P.J., Burgel, P.R., Calverley, P.M., Casanova, C., Clini, E.M., Cooper, C.B., & Coxson, H.O. (2015). ATS/ERS Task Force for COPD Research An Official American Thoracic Society/European Respiratory Society Statement: Research questions in chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine. 191 (7), e4–e27. DOI: 10.1164/rccm.201501-0044ST.
GBD (2019) Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England). 396,10258: 1204-1222. DOI: 10.1016/S0140-6736(20)30925-9.
Oleksіak, O., & Heriak, S. (2022). Zminy markeriv funktsiyi endoteliyu, perekysnoho okyslennya lipidiv ta antyoksydantnoho zakhystu u vahitnykh iz khronichnym obstruktyvnym zakhvoryuvannyam lehenʹ [Changes in markers of endothelial function, lipid peroxidation and antioxidant defense in pregnant women with chronic obstructive pulmonary disease]. Neonatolohiya, khirurhiya ta perynatalʹna medytsyna - Neonatology, surgery and perinatal medicine, 12 (2): 44, 38-43. DOI: 10.24061/2413-4260.XII.2.44.2022.7. [in Ukrainian].
Heriak, S.M., & Oleksiak, O.I. (2023). The influence of systemic inflammatory markers on the development of obstetrical complications in pregnant women with chronic obstructive pulmonary disease. Zaporozhye medical Journal. 25 (1), 35-40. DOI:10.14739/2310-1210.2023.1.264437.
Yang, I.A., Jenkins, C.R., & Salvi, S.S. (2022). Chronic obstructive pulmonary disease in never-smokers: risk factors, pathogenesis, and implications for prevention and treatment. The Lancet. Respiratory medicine. 10(5), 497-511. DOI: 10.1016/S2213-2600(21)00506-3.
Martinez, F.J., Han, M.K., Allinson, J.P., Barr, R.G., Boucher, R.C., Calverley, P.M.A., Celli, B.R., Christenson, S.A., Crystal, R.G., Fagerås, M., Freeman, C.M., Groenke, L., Hoffman, E.A., Kesimer, M., Kostikas, K., Paine, R. 3rd, Rafii, S., Rennard, S.I., Segal, L.N., Shaykhiev, R., Stevenson, C., Tal-Singer, R., Vestbo, J., Woodruff, P.G., Curtis, J.L., & Wedzicha, J.A. (2018). At the root: defining and halting progression of early chronic obstructive pulmonary disease. Am J Respir Crit Care Med., 197(12), 15, 1540-51. DOI: 10.1164/rccm.201710-2028PP.
DeMeo, D.L., Ramagopalan, S., Kavati, A., Vegesna, A., Han, M.K., Yadao, A., Wilcox, T.K., & Make, B.J. (2018). COPDGene Investigators. Women manifest more severe COPD symptoms across the life course. Int J Chron Obstruct Pulmon Dis., 1(13), 3021-29. DOI: 10.2147/COPD.S160270. PMID: 30319250; PMCID: PMC6171761.
Ntritsos, G., Franek, J., Belbasis, L., Christou, M.A., Markozannes, G., Altman, P., Fogel, R., Sayre, T., Ntzani, E. E., & Evangelou, E. (2018). Gender-specific estimates of COPD prevalence: a systematic review and meta-analysis. International journal of chronic obstructive pulmonary disease, 13, 1507-1514. DOI:10.2147/COPD.S146390.
Jarhyan, P., Hutchinson, A., Khaw, D., Prabhakaran, D., & Mohan, S. (2022). Prevalence of chronic obstructive pulmonary disease and chronic bronchitis in eight countries: a systematic review and meta-analysis. Bulletin of the World Health Organization, 100(3), 216-230. DOI: 10.2471/BLT.21.286870.
Han, M.L.K. (2020). Chronic Obstructive Pulmonary Disease in women: a biologically focused review with a systematic search strategy. International journal of chronic obstructive pulmonary disease, 1(15), 711-721. DOI: 10.2147/COPD.S237228.
Tsiligianni, I., Rodríguez, M.R., Lisspers K., & et al. (2017). Call to action: improving primary care for women with COPD. NPJ primary care respiratory medicine, 27(1):15, 11. DOI: 10.1038/s41533-017-0013-2.
Sørheim, I.-C, Johannessen, A., Gulsvik, A., Bakke, P.S., Silverman, E. K., DeMeo, D.L. (2010). Gender differences in COPD: are women more susceptible to smoking effects than men? Thorax. 65(6), 480-5. DOI: 10.1136/thx.2009.122002.
Zysman, M., & Raherison-Semjen, C. (2022). Women's COPD. Frontiers in medicine. 8, 600107. DOI: 10.3389/fmed.2021.600107.
Bravo-Solarte, D.C., Garcia-Guaqueta, D.P., & Chiarella, S. E. (2023). Allergy and asthma proceedings, 44 (1), 24-34. DOI: 10.2500/aap.2023.44.220077.
Lao, T.T., & Annie Hui, S.Y. (2022). The obstetric aspects of maternal asthma. Best practice & research. Clinical obstetrics & gynaecology. 85(Pt A), 57-69. DOI: 10.1016/j.bpobgyn.2022.08.005.
Murphy, V.E., Gibson, P.G., & Schatz, M. (2023). Managing asthma during pregnancy and the postpartum period. The journal of allergy and clinical immunology. In practice, 11(12), 3585-3594. DOI: 10.1016/j.jaip.2023.07.020.
Bulavenko, O.V., Oleksiyenko, I.V., & Prolyhina, I.V. (2021). Otsinka klinichnoyi efektyvnosti preventyvnoyi terapiyi u vahitnykh zhinok iz vyrazkovym kolitom [Evaluation of the clinical effectiveness of preventive therapy in pregnant women with ulcerative colitis]. Visnyk Vinnytsʹkoho natsionalʹnoho medychnoho universytetu - Bulletin of the Vinnytsia National Medical University . 25(2), 271-276. DOI: 10.31393/reports-vnmedical-2021-25(2)-15. [in Ukrainian].
Medved, V.I., & Popovich, V.I. (2020). Zakhvoryuvannya verkhnikh dykhalʹnykh shlyakhiv u vahitnykh [Diseases of the upper respiratory tract in pregnant women]. Reproduktyvne zdorovʺya zhinky - Reproductive health of a woman. 3(3), 12-17. DOI: 10.30841/2708-8731.3.2020.214940. [in Ukrainian].
MOZ Ukrayiny [Ministry of Health of Ukraine] (2013). Khronichne obstruktyvne zakhvoryuvannya leheni: adaptovana klinichna nastanova, zasnovana na dokazakh : nakaz № 555/2013. 27.06.2013. 146c.
[Chronic obstructive pulmonary disease treatment: adapted evidence-based clinical guideline: Order No. 555/2013. 27.06.2013. 146p]. Retrieved from https://zakon.rada.gov.ua/rada/show/v0555282-13. [in Ukrainian].
GOLD Report (2020) From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020. Retrieved from https://goldcopd.org/gold-reports/.
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