Combined prevention of fetal growth restriction based on determination of diagnostic markers

Keywords: Aspirin, low molecular weight heparin (LMWH), fetal growth restriction, pregnancy-associated plasma protein A (PAPP-A), mean platelet volume (MPV), ultrasound diagnostics (USD)

Abstract

Due to the morbidity of mothers and newborns caused by fetal growth restriction (FGR) and preeclampsia, preventive measures should be taken, especially in women at high risk of developing these conditions. Many studies have been conducted on the prevention of FGR and preeclampsia in high-risk women, especially anticoagulants, aspirin, paravastatin, nitric oxide, microelements (L-arginine, folic acid, vitamins E and C, phytonutrients, vitamin D) and calcium.

The aim is to improve perinatal consequences by preventing FGR in high-risk women.

Materials and methods: A prospective study of 137 pregnant women in the period of 110–136 weeks was conducted at the Perinatal Center in Kyiv. Pregnant women were divided into 3 groups. The main group included 47 women at high risk of FGR who received therapy (low doses of aspirin, low molecular weight heparin (LMWH) and vitamin and micro elements drugs). The comparison group included 45 women who had a high risk of FGR but did not receive treatment. The control group consisted of 45 women who were not at risk of FGR. The frequency of FGR and placental dysfunction were analyzed as well as a fetal distress was analyzed ante- and intranatally.

Results: Therapy with low doses of aspirin, LMWH and a complex preparation of vitamins and micro elements improves the course of pregnancy and gestational complications. In the main group FGR was detected in 8.5 %, in the comparison group – in 17.8 %, in the control group – 4.4 %. Placental dysfunction was detected in 13.3 % in the control group, and only 6.4 % in the main group that was close to the control group – 2.2 %. Similar tendencies were found for fetal distress ante- and intranatally.

Conclusions: The proposed prophylactic measures can improve maternal outcomes by reducing the level of gestational complications in pregnant women with biochemical signs of risk of FGR development. In addition, these preventive measures can reduce the frequency of children births with growth restriction, which significantly reduces early neonatal and perinatal morbidity and mortality.

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Author Biography

Vladimir Golyanovskyi, Shupyk National Healthcare University of Ukraine; Kyiv Perinatal Center

Department of Obstetrics, Gynecology, Perinatology  No. 1

Obstetric Department

References

Rolnik, D. L., Wright, D., Poon, L. C., O’Gorman, N., Syngelaki, A., de Paco Matallana, C. et. al. (2017). Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. New England Journal of Medicine, 377 (7), 613–622. doi: http://doi.org/10.1056/nejmoa1704559

Haddad, B., Winer, N., Chitrit, Y., Houfflin-Debarge, V., Chauleur, C. et. al. (2016). Enoxaparin and Aspirin Compared With Aspirin Alone to Prevent Placenta-Mediated Pregnancy Complications: A Randomized Controlled Trial. Obstetrics & Gynecology, 128 (5), 1053–1063. doi: http://doi.org/10.1097/aog.0000000000001673

Roberge, S., Nicolaides, K., Demers, S., Hyett, J., Chaillet, N., Bujold, E. (2017). The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 216 (2), 110–120.e6. doi: http://doi.org/10.1016/j.ajog.2016.09.076

Meher, S., Duley, L., Hunter, K., Askie, L. (2017). Antiplatelet therapy before or after 16 weeks’ gestation for preventing preeclampsia: an individual participant data meta-analysis. American Journal of Obstetrics and Gynecology, 216 (2), 121–128.e2. doi: http://doi.org/10.1016/j.ajog.2016.10.016

Rodger, M. A., Gris, J.-C., de Vries, J. I. P., Martinelli, I., Rey, É., Schleussner, E. et. al. (2016). Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomised controlled trials. The Lancet, 388 (10060), 2629–2641. doi: http://doi.org/10.1016/s0140-6736(16)31139-4

Mousavi, S., Moradi, M., Khorshidahmad, T., Motamedi, M. (2015). Anti-Inflammatory Effects of Heparin and Its Derivatives: A Systematic Review. Advances in Pharmacological Sciences, 2015, 1–14. doi: http://doi.org/10.1155/2015/507151

Abheiden, C., Van Hoorn, M., Hague, W., Kostense, P., van Pampus, M., de Vries, J. (2015). Does low-molecular-weight heparin influence fetal growth or uterine and umbilical arterial Doppler in women with a history of early-onset uteroplacental insufficiency and an inheritable thrombophilia? Secondary randomised controlled trial results. BJOG: An International Journal of Obstetrics & Gynaecology, 123 (5), 797–805. doi: http://doi.org/10.1111/1471-0528.13421

Mastrolia, S., Novack, L., Thachil, J., Rabinovich, A., Pikovsky, O., Klaitman, V. et. al. (2016). LMWH in the prevention of preeclampsia and fetal growth restriction in women without thrombophilia: A systematic review and meta-analysis. Thrombosis and Haemostasis, 116 (11), 868–878. doi: http://doi.org/10.1160/th16-02-0169

Rodger, M. A., Carrier, M., Le Gal, G., Martinelli, I., Perna, A., Rey, É. et. al. (2014). Meta-analysis of low-molecular-weight heparin to prevent recurrent placenta-mediated pregnancy complications. Blood, 123 (6), 822–828. doi: http://doi.org/10.1182/blood-2013-01-478958

Oyston, C., Stanley, J. L., Oliver, M. H., Bloomfield, F. H., Baker, P. N. (2016). Maternal Administration of Sildenafil Citrate Alters Fetal and Placental Growth and Fetal–Placental Vascular Resistance in the Growth-Restricted Ovine Fetus. Hypertension, 68 (3), 760–767. doi: http://doi.org/10.1161/hypertensionaha.116.07662

Laakkonen, J. P., Ylä-Herttuala, S. (2015). Recent Advancements in Cardiovascular Gene Therapy and Vascular Biology. Human Gene Therapy, 26 (8), 518–524. doi: http://doi.org/10.1089/hum.2015.095

Beards, F., Jones, L. E., Charnock, J., Forbes, K., Harris, L. K. (2017). Placental Homing Peptide-microRNA Inhibitor Conjugates for Targeted Enhancement of Intrinsic Placental Growth Signaling. Theranostics, 7 (11), 2940–2955. doi: http://doi.org/10.7150/thno.18845

Bland, M. (1995). An Introduction to Medical Statistics. Oxford University Press, 168.

Guerby, P., Bujold, E. (2020). Early Detection and Prevention of Intrauterine Growth Restriction and Its Consequences. JAMA Pediatrics, 174 (8), 749. doi: http://doi.org/10.1001/jamapediatrics.2020.1106

Henderson, J. T., Whitlock, E. P., O'Conner, E. et. al. (20014). Rockville (MD): Low-Dose Aspirin for the Prevention of Morbidity and Mortality From Preeclampsia: A Systematic Evidence Review for the U.S. Preventive Services Task Force Agency for Healthcare Research and Quality. Evidence Syntheses, No. 112.

McLaughlin, K., Baczyk, D., Potts, A., Hladunewich, M., Parker, J. D., Kingdom, J. C. P. (2017). Low Molecular Weight Heparin Improves Endothelial Function in Pregnant Women at High Risk of Preeclampsia. Hypertension, 69 (1), 180–188. doi: http://doi.org/10.1161/hypertensionaha.116.08298

Groom, K. M., McCowan, L. M., Mackay, L. K., Lee, A. C., Said, J. M., Kane, S. C. et. al. (2017). Enoxaparin for the prevention of preeclampsia and intrauterine growth restriction in women with a history: a randomized trial. American Journal of Obstetrics and Gynecology, 216 (3), 296.e1–296.e14. doi: http://doi.org/10.1016/j.ajog.2017.01.014

Yinon, Y., Ben Meir, E., Margolis, L., Lipitz, S., Schiff, E., Mazaki-Tovi, S., Simchen, M. J. (2015). Low molecular weight heparin therapy during pregnancy is associated with elevated circulatory levels of placental growth factor. Placenta, 36 (2), 121–124. doi: http://doi.org/10.1016/j.placenta.2014.12.008

Rodger, M. A., Hague, W. M., Kingdom, J., Kahn, S. R., Karovitch, A., Sermer, M. et. al. (2014). Antepartum dalteparin versus no antepartum dalteparin for the prevention of pregnancy complications in pregnant women with thrombophilia (TIPPS): a multinational open-label randomised trial. The Lancet, 384 (9955), 1673–1683. doi: http://doi.org/10.1016/s0140-6736(14)60793-5

McCowan, L. M., Figueras, F., Anderson, N. H. (2018). Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. American Journal of Obstetrics and Gynecology, 218 (2), S855–S868. doi: http://doi.org/10.1016/j.ajog.2017.12.004


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Published
2021-05-25
How to Cite
Golyanovskyi, V. (2021). Combined prevention of fetal growth restriction based on determination of diagnostic markers. EUREKA: Health Sciences, (3), 9-15. https://doi.org/10.21303/2504-5679.2021.001849
Section
Medicine and Dentistry