Preconceptional assessment of endothelial dysfunction markers in women with antenatal fetal death in anamnesis
DOI:
https://doi.org/10.15574/HW.2025.3(178).5966Keywords:
antenatal fetal death, preconceptional preparation, endothelial dysfunction, thrombophilia, antiphospholipid syndrome, endothelin-1Abstract
Identification of endothelial dysfunction markers at stage of pregnancy planning enables risk stratification for prethrombotic conditions, optimization of preconception management strategies, and prevention of complications of pregnancy and childbirth in women with a history of antenatal fetal death (AFD).
Аim - to identify markers of endothelial dysfunction and the features of polymorphism of the encoding them genes, in women with a history of AFD at the stage of preconception preparation.
Materials and methods. At the stage of pregnancy planning, 38 women with a history of AFD (main group) and 35 women whose previous pregnancies resulted in live births (control group) were examined. Gene polymorphisms of coagulation factor V (FV Leiden) and 5,10-methylenetetrahydrofolate reductase (MTHFR) were determined using an allele-specific polymerase chain reaction. The presence of specific antiphospholipid antibodies and their cofactors, as well as the levels of vascular endothelial growth factor (VEGF), endothelin-1 (ET-1), and homocysteine were assessed by enzyme-linked immunosorbent assay (ELISA).
Results. In women of the main group, gene polymorphisms associated with inherited thrombophilia were diagnosed 2.3 times more frequently overall. Specifically, the frequency of FV Leiden was threefold higher, MTHFR polymorphism - 3.4 times higher, prothrombin gene mutation - 5.5 times higher, and plasminogen activator inhibitor (PAI-1) polymorphism - 8.5 times higher compared to the control group. The homocysteine level in the main group exceeded that of the control group by 2.4 times. Antiphospholipid antibodies were detected three times more often in the main group and, in combination with inherited thrombophilia gene polymorphisms, were present in 21.1% of cases. A significant 3.1-fold decrease in VEGF levels and a 2.1-fold increase in ET-1 concentration were observed in women of the main group compared with the control group (6.4±0.4 pg/mL respectively 3.1±0.2 pg/mL).
Conclusions. Determination of gene mutations associated with thrombophilia, antiphospholipid antibodies, and markers of endothelial dysfunction in women with a history of antenatal fetal death will enable timely adjustment of pregnancy management strategies and prevention of recurrent fetal and neonatal losses. The study was conducted in accordance with the principles of the Declaration of Helsinki.
The research protocol was approved by the Bioethics Committee of the Bogomolets National Medical University. Informed consent was obtained from all participants prior to their inclusion in the study.
The authors declare no conflict of interest.
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