Hemorheological profiles of women who used assisted reproductive technologies in relation to the way of getting pregnant: УДК 616-005.1-08

Abstract

Summary. Introduction. In the structure of obstetric complications of pregnancy that occurred with the use of assisted reproductive technologies (ART), a significant role belongs to a complex of factors, including impaired hemorheology, dysregulation of hemostatic parameters, and endothelial dysfunction with a decrease in its antithrombotic properties. Despite the accumulated knowledge, questions remain open that reflect the features of hemorheological and microcirculatory factors at different gestation periods, depending on the method of pregnancy following ART, which may be important for the development of new methods of hemocorrection and the choice of treatment tactics in the management of patients in IVF programs. Aim: to study rheological characteristics of blood during pregnancy after IVF at different gestational periods. Materials and Methods. We conducted a closed prospective controlled cohort longitudinal observational randomized study that included 126 patients who were divided into 4 groups depending on the way of getting pregnant. To assess blood rheological parameters at different periods of gestation we selected 3 examination points: I trimester (7–8 weeks); II trimester (19–21 weeks); III trimester (30–34 weeks). At the selected dates, all patients underwent a comprehensive clinical, instrumental and laboratory examination. Along with a standard laboratory examination, erythrocyte rheological characteristics, platelet aggregation capacity and the level of ADAMTS-13 metalloprotease were studied at different periods of gestation. Results. The highest frequency of gestational complications (84.4%) was observed in the group of patients with donor oocytes (group I), and the lowest (34.5%) — in the group with spontaneous pregnancy (group IV). The highest frequency of threatened abortion in the first (68.7%) and second (34.3%) trimesters was also determined in the group of patients with donor oocytes (group I), while threatened preterm labor (in 66.7% of cases) and placental abruption (in 23.3% of cases) were more often detected in the group of surrogate mothers (group II). Rheological erythrocyte characteristics in the first trimester of pregnancy were significantly impaired in groups I (with the greatest severity) and III compared with women with spontaneous pregnancy (group IV) and surrogate mothers (group II). Rheological characte ristics such as aggregation amplitude, aggregation index and the rate of complete disaggregation (γ-dis), reflecting the density of erythrocyte aggregates, were statistically significantly higher in groups of patients I and III compared with the women from groups II and IV. Significant differences were also observed in the erythrocyte deformability that was significantly reduced in groups I and III. During the gestation period in groups I and III with initially impaired blood rheological characteristics, as the gesta tion period increased, a pattern of changes progression in both macro and microrheological blood parameters was observed with the greatest severity of these disorders in women with donor oocytes (group I). The hemorheological profile of the gesta tion period in group II was characterized by the following: with normal hemorheological parameters in the first trimester, there was a sharp and significant deterioration of all macro and microrheological characteristics in the second trimester (p=0.000) for all studied parameters, except platelet aggregation with ADP, adrenaline and collagen. Conclusion. When managing preg nant women after IVF programs, an individual approach to each patient is necessary, depending on the way of getting pregnant following the ART. Anamnestic data should be thoroughly analyzed to determine the degree of thrombotic risk and the need for additional examination, taking into account blood rheological parameters. The revealed changes in macro and microrheolo gical blood parameters in pregnant women after IVF are determined by the peculiarities of preparing for pregnancy, premorbid background, hormone therapy used before the gestational period and during pregnancy, which contributes to the impairment of protective and adaptive mechanisms at the cellular level. These factors are of particular importance for the management of pregnant women in the “Surrogacy” programs. For citation: Shabalina A.A., Roitman E.V., Soboleva V.V., Alexandrov L.S., Tanashyan M.M., Balyasin M.M. Hemorheological profiles of women who used assisted reproductive technologies in relation to the way of getting pregnant. Tromboz, gemostaz i reologiya. 2023;(2):6–16. (In Russ.).

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