Perinatal outcomes among women with reproductive losses in their anamnesis

• Igitova M.B.
• Safarova G.A.
• Olga V. Remneva
• Elena S. Kravtsova

Abstract

Goal - to estimate the course of pregnancy and the condition of newborns among women with reproductive losses in their anamnesis, depending on the particular qualities of the folatic preventive measures during pregravidar preparation stage and first trimester of gestation.

Patients and methods. 253 women were divided into two groups, depending on whether they had reproductive losses in their anamnesis (1^st, n=65) or they didn't (2^nd group, n=188). A comparative analysis of the course of pregnancy and its outcome for the newborn was performed in both groups. For all patients, a molecular genetic testing of DNA was performed in order to determine a factor V (FV) gene polymorphism, factor II (FII) gene polymorphism, Plasminogen Activator Inhibitor-1 (PAI-1) and Methylenetetrahydrofolate Reductase (MTHFR). Group I patients, starting from the pregravidar stage, were prescribed to take folates in the form of synthetic folic acid (400-800 mg). To estimate the effectiveness of the folate preventive measures on the perinatal outcome, a pregnancy course and delivery outcome analysis was performed among 65 women with reproductive losses in their anamnesis (3^d group), who were taking folates in the form of 200 mg of folic acid and 208 mg of metafolin.

Results. Pregnant women with reproductive losses in their anamnesis had premature deliveries more often (10.8 and 3.2%, p=0.039). Perinatal outcomes in this group were characterized by the high rate of hypoxic-ischemia damage of central nervous system and moving newborns to the second stage of treatment (23.1 and 12.2%, p=0.05). There were no significant differences in the PAI-1, FV and FII polymorphism detection rate between 1^st group and 2^nd group, but there was a statistically significant increase in rate of the MTHFR homozygous polymorphism in the group I (10.8 and 2.7%, p=0.021). Women with reproductive losses in their anamnesis who were taking folates in the form of 200 mg of folic acid and 208 mg of metafolin (3^d group) starting from the pregravidar stage, had premature delivery and perinatal complications less often with high degree of certainty, comparing to women who were taking folates in the form of synthetic folic acid.

Conclusion. Reproductive losses in the anamnesis increase perinatal risk. Statistically significant increased rate of the MTHFR homozygous polymorphism among women with reproductive losses in their anamnesis, confirms the correlation between the folate metabolism gene polymorphism and the higher risk of premature delivery. Using medication containing metabolically active form of folate during pregravidar preparation stage and the first trimester of pregnancy, helps reducing the rate of premature deliveries and improving perinatal outcomes.

Keywords:pregnancy, reproductive losses, perinatal outcomes

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