Clinical efficacy of pregravid preparation in induced pregnancy on a background of thyroid gland pathology

Т. Г. Романенко, О. І. Чайка

Abstract


The aim of study. To increase the efficiency of reproductive function restoration in women with infertility on the background of thyroid gland pathology, prevent miscarriage, reduce the incidence of gestational complications, improve perinatal outcomes and reduce neonatal morbidity.

Study design. 221 women with infertility on the background of thyroid pathology were examined. Patients were divided into two clinical groups. The group I consisted of 92 women with induced pregnancies (IB) who received pregravid preparation: oral Ogestan® micronutrient complex (potassium iodide in a daily dose of 150 μg, folic acid 400 mg, vitamin D 5 μg, omega-3 fatty acids 200 mg docosahexaenoic acid, vitamin E 12 mg), micronized progesterone (Utrogestan®) 200 mg in the II phase of the menstrual cycle was intravaginal. Group II (129 women) with IB did not receive pregravid preparation.

Results. In the group I 56 women (60.9%) became pregnant after induction of pregnancy, in the group II – 62 women (48.1%). The level of hormones in the serum showed the clinical effectiveness of pregravid preparation according to the method proposed by the authors. Thus, in pregnant women of group I low normal levels of TSH and high normal levels of free T4 were noted, which is a prognostically favorable index for the induction of ovulation. On the levels of progesterone and estradiol in pregnant women of group II, the stress of functioning of the mother-placenta-fetus system was noted, which led to a significantly high frequency of obstetric and perinatal complications. Analysis of the flow of pregnancy and childbirth in the group I showed a significantly lower frequency of a number of complications, which led to a significantly lower frequency of abdominal delivery (64.0%) and neonatal morbidity in the early neonatal period (14.8%).

Conclusion. The inclusion of the Ogestan® complex in the schemes of pregravid preparation of women with infertility on the background of pathology of the thyroid gland is an effective way to replace the deficiency of the most important micronutrients and can be recommended for practical use.


Keywords


thyroid pathology; induced pregnancy; pregravid preparation

References


Perminova, S.G. Infertility in women with thyroid pathology: principles of diagnosis, tactics of reference. Thesis abstract for PhD degree. Moscow (2010): 34 p.

World Health Organization. Guideline: Vitamin D supplementation in pregnant women. World Health Organization (2012).

De Groot, L., et al. “Management of thyroid dysfunction during pregnancy and postpartum: An Endocrine Society clinical practice guideline.” J Clin Endocrinol Metab 97 (2012): 2543.

Hollis, B.W., Johnson, D., Hulsey, T.C., et al. “Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness.” J Bone Miner Res 26.12 (2011): 3001.

World Health Organization. Fats and Fatty Acids in Human in Nutrition. Joint FAO/WHO Expert Consultation, November 10–24, 2008, Geneva, Switzerland.

Wolff, T., Witkop, C.T., Miller, T., Syed, S.B. “Folic acid supplementation for the prevention of neural tube defects: an update of the evidence for the U. S. Preventive Services Task Force.” Ann Intern Med 150 (2009): 632.

Pustotina, O.A., Akhmedova, A.E. “The role of folates in the development of complications of pregnancy.” Effective pharmacotherapy 35 (2014).

Pal Suren, et al. “Association Between Maternal Use of Folic Acid Supplements and Risk of Autism Spectrum Disorders in Children.” JAMA 6.309 (2013).

StatusPraesens, 2015. – 8 c. Recommendations of the International Federation of Obstetricians and Gynecologists (2015). Perfection of practical approaches in obstetrics and fetal medicine. Newsletter. Ed. by V.E. Radzinsky. Moscow. Editorial Board of the StatusPraesens Journal (2015): 8 p.

De-Regil, L.-M., et al. “Effects and safety of periconceptional oral folate supplementation for preventing birth defects.” Cochrane Database Syst Rev 14.12 (2015): CD007950. DOI: 10.1002/14651858.CD007950.pub3

Di Renzo, G.C., et al. “Guidelines for the management of spontaneous preterm labour.” J Fetal Neonatal Med 24.5 (2011): 659–67.

American College of Obstetricians and Gynecologists. “ACOG practice bulletin No. 130: prediction and prevention of preterm birth.” Obstet Gynecol 120.4 (2012): 964–73.

Preterm Birth Prevention: Evidence-Based Use of Progesterone Treatment Issue Brief and Action Steps for Medicaid Health Plans (2014). Available from: [http://www.mhpa.org/_upload/PTBIssueBrief111714MHPA.pdf].

Romero, R., Nicolaides, K., Conde-Agudelo, A., et al. “Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data.” Am J Obstet Gynecol 206 (2012): e1–19.

Cetingoz, E., Cam, C., Sakalli, M., et al. “Progesterone effects on preterm birth in high-risk pregnancies: a randomized placebocontrolled trial.” Arch Gynecol Obstet 283 (2011): 423–9.

Prevention of miscarriage and premature birth in the modern world. Resolution of the Expert Council within the framework of the 16th World Congress on Human Reproduction. Berlin, March 18–21, 2015. Information letter. Moscow. Editorial board of the StatusPraesens Journal (2015): 4 p.

Hassan, S.S., Romero, R., Vidyadhari, D., et al.; PREGNANT Trial. “Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial.” Ultrasound Obstet Gynecol 38.1 (2011): 18–31.

Zarutskie, P.W., Phillips, J.A. “A meta-analysis of the route of administration of luteal phase support in assisted reproductive technology: vaginal versus intramuscular progesterone.” Fertil Steril 92.1 (2009): 163–9.

Vaisbuch, E., De Ziegler, D., Leong, M., et al. “Luteal-phase support in assisted reproduction treatment: real-life practices reported worldwide by an updated website-based survey.” Reprod Biomed Online 28.3 (2014): 330–5.

Practice Committee of the American Society for Reproductive Medicine. “Current clinical irrelevance of luteal phase deficiency: a committee opinion.” Fertil Steril 103.4 (2015): e27–e32.

Kupka, M.S., Ferraretti, A.P., De Mouzon, J., et al. “European IVF-Monitoring Consortium, for the European Society of Human Reproduction and Embryology Assisted reproductive technology in Europe, 2010: results generated from European registers by ESHRE.” Hum Reprod 29.10 (2014): 2099–113.


GOST Style Citations


1. Перминова, С.Г. Бесплодие у женщин с патологией щитовидной железы: принципы диагностики, тактика ведения: автореф. дис. … канд. мед. наук / С. Г. Перминова. – М., 2010. – 34 с.

2. World Health Organization. Guideline: Vitamin D supplementation in pregnant women. World Health Organization (2012).

3. De Groot, L., et al. “Management of thyroid dysfunction during pregnancy and postpartum: An Endocrine Society clinical practice guideline.” J Clin Endocrinol Metab 97 (2012): 2543.

4. Hollis, B.W., Johnson, D., Hulsey, T.C., et al. “Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness.” J Bone Miner Res 26.12 (2011): 3001.

5. World Health Organization. Fats and Fatty Acids in Human in Nutrition. Joint FAO/WHO Expert Consultation, November 10–24, 2008, Geneva, Switzerland.

6. Wolff, T., Witkop, C.T., Miller, T., Syed, S.B. “Folic acid supplementation for the prevention of neural tube defects: an update of the evidence for the U. S. Preventive Services Task Force.” Ann Intern Med 150 (2009): 632.

7. Пустотина, О.А. Роль фолатов в развитии осложнений беременности / О.А. Пустотина, А.Э. Ахмедова // Эффективная фармакотерапия. – 2014. – Вып. 35.

8. Pal Suren, et al. “Association Between Maternal Use of Folic Acid Supplements and Risk of Autism Spectrum Disorders in Children.” JAMA 6.309 (2013).

9. Рекомендации Международной федерации акушеров-гинекологов (2015). Совершенствование практических подходов в акушерстве и фетальной медицине. Информационный бюллетень / Под ред. В.Е. Радзинского. – М.: Редакция журнала

10. De-Regil, L.-M., et al. “Effects and safety of periconceptional oral folate supplementation for preventing birth defects.” Cochrane Database Syst Rev 14.12 (2015): CD007950. DOI: 10.1002/14651858.CD007950.pub3

11. Di Renzo, G.C., et al. “Guidelines for the management of spontaneous preterm labour.” J Fetal Neonatal Med 24.5 (2011): 659–67.

12. American College of Obstetricians and Gynecologists. “ACOG practice bulletin No. 130: prediction and prevention of preterm birth.” Obstet Gynecol 120.4 (2012): 964–73.

13. Preterm Birth Prevention: Evidence-Based Use of Progesterone Treatment Issue Brief and Action Steps for Medicaid Health Plans (2014). Available from: [http://www.mhpa.org/_upload/PTBIssueBrief111714MHPA.pdf].

14. Romero, R., Nicolaides, K., Conde-Agudelo, A., et al. “Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data.” Am J Obstet Gynecol 206 (2012): e1–19.

15. Cetingoz, E., Cam, C., Sakalli, M., et al. “Progesterone effects on preterm birth in high-risk pregnancies: a randomized placebocontrolled trial.” Arch Gynecol Obstet 283 (2011): 423–9.

16. Профилактика невынашивания и преждевременных родов в современном мире. Резолюция Экспертного совета в рамках 16-го Всемирного конгресса по вопросам репродукции человека (Берлин, 18–21 марта 2015 года): Информационное письмо. – М.: Редакция журнала StatusPraesens, 2015. – 4 с.

17. Hassan, S.S., Romero, R., Vidyadhari, D., et al.; PREGNANT Trial. “Vaginal progesterone reduces the rate of preterm birth in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial.” Ultrasound Obstet Gynecol 38.1 (2011): 18–31.

18. Zarutskie, P.W., Phillips, J.A. “A meta-analysis of the route of administration of luteal phase support in assisted reproductive technology: vaginal versus intramuscular progesterone.” Fertil Steril 92.1 (2009): 163–9.

19. Vaisbuch, E., De Ziegler, D., Leong, M., et al. “Luteal-phase support in assisted reproduction treatment: real-life practices reported worldwide by an updated website-based survey.” Reprod Biomed Online 28.3 (2014): 330–5.

20. Practice Committee of the American Society for Reproductive Medicine. “Current clinical irrelevance of luteal phase deficiency: a committee opinion.” Fertil Steril 103.4 (2015): e27–e32.

21. Kupka, M.S., Ferraretti, A.P., De Mouzon, J., et al. “European IVF-Monitoring Consortium, for the European Society of Human Reproduction and Embryology Assisted reproductive technology in Europe, 2010: results generated from European registers by ESHRE.” Hum Reprod 29.10 (2014): 2099–113.





DOI: https://doi.org/10.18370/2309-4117.2017.37.19-25

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