ТHE IMPACT OF THE PROPOSED THERAPEUTIC AND PREVENTIVE COMPLEX ON THE HEMOSTASIS SYSTEM, ENDOTHELIAL, AND IMMUNE STATUS IN PREGNANT WOMEN FOLLOWING ASSISTED REPRODUCTIVE TECHNOLOGIES
DOI:
https://doi.org/10.11603/24116-4944.2024.2.14987Keywords:
pregnancy, miscarriage, childbirth, perinatal outcomes, endothelial dysfunction, assisted reproductive technologiesAbstract
The aim of the study – to determine the state of the hemostasis system and endothelial factors in women after the use of assisted reproductive technologies (ART) based on the proposed therapeutic and preventive complex.
Materials and Methods. A prospective study was conducted involving 299 pregnant women, categorized according to the type of infertility and management approach: Group I – 94 women with tubal-peritoneal infertility. Group II – 87 women with endocrine infertility. Group III – 68 women with male-factor infertility. Control group – 50 pregnant women with spontaneous conception and physiological pregnancy progression. Depending on the treatment approach, Subgroup A included pregnant women who received the proposed therapeutic complex, while Subgroup B – pregnant women treated according to standard obstetric care protocols. Therefore, Subgroup IA included 49 women, Subgroup IB – 45 women, Subgroup IIA – 48 women, Subgroup IIB – 39 women, Subgroup IIIA – 36 women, Subgroup IIIB – 32 women. Blood samples were taken from the cubital vein to assess homocysteine levels (ELISA, AXIS-SHIELD reagents, UK; Stat Fax 2100 analyzer, USA), coagulogram parameters (four-channel coagulation analyzer Coag 4D, Diagon, Hungary), Endothelin-1 (ELISA, Biomedica reagents, UK; Stat Fax 2100 analyzer, USA), VEGF levels (ELISA, Biotin Conc reagents, UK; Stat Fax 2100 analyzer, USA). The proposed therapeutic and preventive complex included progesterone support, magnesium supplementation, folic acid, L-arginine aspartate, omega-3 polyunsaturated fatty acids, long-term psychological correction.
Results and Discussion. The proposed therapeutic and diagnostic complex demonstrated positive effects by influencing:
- a) homocysteine concentration – a significant reduction in homocysteine levels in subgroup A compared to subgroup B (e.g., IA: 8.2±1.4 mmol/L vs. IB: 20.3±1.8 mmol/L, p<0.05). Reduction in miscarriage risk in Group I by 41.6% (Group I before treatment: 70.2%; subgroup IA: 28.6%, p<0.05). Decreased spontaneous miscarriage cases in Group I (subgroup IA: 28.6%, subgroup IB: 57.7%, p<0.05).
- b) coagulation hemostasis – normalization of fibrinogen levels (IA: 3.2±0.2 g/L, IB: 4.1±0.1 g/L, p<0.05), reduced D-dimer (IA: 241.5±11.6 ng/mL, IB: 517.3±12.1 ng/mL, p<0.05), decreased soluble fibrin monomer complexes (RFMK) (IA: 0.39±0.2, IB: 0.55±0.1, p<0.05).
- c) endothelial status – lower VEGF levels (e.g., IA: 38.4±6.1 pg/mL, IB: 321.8±14.6 pg/mL, p<0.05), reduced endothelin-1 levels (e.g., IA: 2.6±0.4 ng/mL, IB: 17.1±3.2 ng/mL, p<0.05).
- d) immune status – improved cellular homeostasis: reduced T-lymphocytes (IA: 0.39±0.04, IB: 0.70±0.13, p<0.05), decreased CD3+ levels (IA: 28.24±1.31, IB: 34.89±1.29, p<0.05), increased CD8+ levels (IA: 17.24±0.33, IB: 14.76±0.34, p<0.05). Enhanced humoral homeostasis: mnormalized B-lymphocyte levels (IA: 28.22±0.61, IB: 24.28±0.9, p<0.05), restored CD22+ cell levels (IA: 0.41±0.02×109/L, IB: 0.52±0.04×109/L, p<0.05).
Conclusions. The proposed therapeutic and diagnostic complex is an effective method for correcting endothelial, hemostatic, and immune status abnormalities in pregnant women after ART. It is recommended for practical use in this group of patients.
References
Maslo, D. (2016). Optymizatsiia taktyky vedennia vahitnosti ta polohiv u zhinok pislia zastosuvannia dopomizhnykh reproduktyvnykh tekhnolohii [Optimization of the tactics of maintaining the importance of women's positions after the use of assisted reproductive technologies]. Zdorove zhenshchyny – Health of a woman, (5), 160-164 [in Ukrainian].
Rubinstein, A. (2022). Taktyka vedennya vahitnosti, polohiv ta pislyapolohovoho periodu u patsiyentok piznʹoho reproduktyvnoho viku z vahitnistyu, yaka nastala za dopomohoyu dopomizhnykh reproduktyvnykh tekhnolohiy [Management of pregnancy, delivery, and postpartum in patients of advanced maternal age with pregnancies obtained by assisted reproductive technologies]. Reproduktyvne zdorovya zhinky – Reproductive Health of Woman, (4), 16–22 [in Ukrainian]. DOI: https://doi.org/10.30841/2708-8731.4.2022.262761
Golyanovskiy О., Zukin, V., Shemyakina, N., & Rubinshtein A. (2021). Osoblyvosti perebihu vahitnosti, polohiv ta pislyapolohovoho periodu na tli zastosuvannya dopomizhnykh reproduktyvnykh tekhnolohiy [Features of pregnancy, delivery and postpartum on the background of assisted reproductive technologies]. Reproduktyvne zdorovya zhinky – Reproductive Health of Woman, (9-10), 79–87 [in Ukrainian]. DOI: https://doi.org/10.30841/2708-8731.9-10.2021.252598
Nevyshnа Y. (2021). Suchasni pohlyady na profilaktyku akushersʹkykh ta perynatalʹnykh uskladnenʹ u zdorovykh vahitnykh: ohlyad literatury [Modern views on the prevention of obstetric and perinatal complications in healthy pregnant women: literature review]. Reproduktyvne zdorovya zhinky – Reproductive Health of Woman, (1), 49-53 [in Ukrainian]. DOI: https://doi.org/10.30841/2708-8731.1.2021.229715
Andriichuk, T., Senchuk, A., & Chermak, V. (2021). Stan systemy maty–platsenta–plid u vahitnykh iz obtyazhenym hinekolohichnym anamnezom [Condition of the mother–placenta–fetal system in pregnant women with a general gynecological anamnesis]. Reproduktyvne zdorovya zhinky – Reproductive Health of Woman, (1), 70–74 [in Ukrainian]. DOI: https://doi.org/10.30841/2708-8731.1.2021.229719
Seliukova, N. Yu., Kustova, S., Boiko, M., Brechka, N., Korenieva, Ye. & Mysiura, K. (2019). Platsentarna nedostatnistʹ: stan problemy ta zasoby rannʹoyi profilaktyky yiyi naslidkiv [Placentar insufficiency: state of problem and early prophylactic effects]. Odeskyi medychnyi zhurnal – Odessa medical journal, (3), 40-45 [in Ukrainian].
Qu, H., & Khalil, R. A. (2020). Vascular mechanisms and molecular targets in hypertensive pregnancy and preeclampsia. Am J Physiol Heart Circ Physiol, 319(3), H661-H681. DOI: https://doi.org/10.1152/ajpheart.00202.2020
Linnikov V., & Linnikov S. (2019). Trombofiliya yak klyuchova lanka patohenezu uskladnenʹ v akusherstvi ta hinekolohiyi [Trombophilia as the main link of pathogenesis of complications in obstetrics and gynecology]. Science and Education, (3), 31-36 [in Ukrainian]. DOI: https://doi.org/10.24195/2414-4665-2019-3-5
Guo J., Feng, Q., Chaemsaithong, P. et al. (2023). Biomarkers at 6 weeks' gestation in the prediction of early miscarriage in pregnancy following assisted reproductive technology. Acta Obstet Gynecol Scand, 102(8), 1073-1083. DOI: https://doi.org/10.1111/aogs.14618
Boichuk, A. V., Ovcharuk, V. V., & Khlibovska, O. I. (2017). Diahnostyka i korektsiia porushen u vahitnykh iz dysfunktsiieiu platsenty [Diagnosis and correction of disorders in pregnant women with placental dysfunction.]. Akusherstvo. Hinekolohiia. Henetyka – Obstetrics. Gynecology. Genetics, 3 (2), 5-7 [in Ukrainian].
Borzenko, I. B. (2020). Prohnozuvannya ta rannya diahnostyka zatrymky rostu ploda u vahitnykh iz platsentarnoyu dysfunktsiyeyu [Prediction and early diagnosis of fetal growth retardation in pregnant women with placental dysfunction]. Doctoral dissertation [in Ukrainian].
Golyanovsky O., Morozova O., & Frolov S. (2023). Hiperhomotsysteyinemiya yak marker akushersʹkoyi patolohiyi [Hyperhomocysteinemia as a marker of obstetric pathology]. Reproduktyvne zdorovya zhinky – Reproductive Health of Woman, (3), 52-59 [in Ukrainian].
MOZ Ukrainy [Ministry of Health of Ukraine]. (2022). Fiziolohichni polohy [Physiological childbirth]. Order No 170 dated 26.01.2022 [in Ukrainian].
MOZ Ukrainy [Ministry of Health of Ukraine]. (2013). Pro zatverdzhennia Instruktsii pro poriadok zastosuvannia dopomizhnykh reproduktyvnykh tekhnolohiy [On approval of the Instructions on the procedure for the use of assisted reproductive technologies] . Order No 787 dated 09.09.2013 [in Ukrainian].
Romero, R., Conde-Agudelo, A., Da Fonseca E. et al. (2018) Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data. Am J Obstet Gynecol, 218(2), 161-180. DOI: https://doi.org/10.1016/j.ajog.2017.11.576
Babenko V., Mokiienko A., Levkovska V. Yu. (2022). Biostatystyka. Navchalno-metodychnyi posibnyk [Biostatistics. A textbook]. Odesa. [in Ukrainian].
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Л. М. Вигівська, І. В. Майданник, О. О. Чорна, Н. М. Гичка, В. М. Комар, К. В. Коливанова

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).