Assessment of the risks of recurrent pregnancy loss in patients with post-traumatic stress disorder

Authors

DOI:

https://doi.org/10.18370/2309-4117.2024.74.48-54

Keywords:

recurrent pregnancy loss, post-traumatic stress disorder, thyroid-stimulating hormone, antiphospholipid antibodies, reproductive loss risk, depression, anxiety, NK cells, psychological support

Abstract

Background. Recurrent pregnancy loss (RPL) is a pressing issue in women’s reproductive health, often accompanied by post-traumatic stress disorder (PTSD). The traumatic experiences arising from repeated reproductive losses not only exhaust a woman’s mental health but also impact endocrine and immunological regulation, which can complicate pregnancy or make it impossible to sustain.
Objective of the study: to identify risk factors for RPL in women with PTSD, specifically in endocrine, immunological, and psycho-emotional dysfunctions that may trigger RPL.
Materials and methods. The study spanned three years (2021–2024) and involved 150 women with RPL, PTSD, or a combination of both. The study was conducted using the parallel group method: the main group (STD and PTSD) with two subgroups consisted of 100 women, the comparison group (STD without PTSD) included 30 women, and the control group (PTSD with a previous successful pregnancy) included 20 women. A thorough clinical examination, laboratory diagnosis of endocrine and immunological parameters was investigated, the psycho-emotional state was determined according to the PCL-C scale and Beck’s questionnaire. For statistical analysis was used the Student’s t-test, calculation of relative measures, mean values, and standard error of the mean.
Results. It was demonstrated elevated levels of thyroid-stimulating hormone and antiphospholipid antibodies in women with combined PTSD and RPL, as well as significantly higher depression and PTSD scores. An increase in NK cells (CD3-CD16/CD56+) indicated the presence of immunological imbalance.
Conclusions. Taking into account the obtained data, the algorithm for RPL prevention in women with PTSD should include the interdisciplinary approach, which contains not only gynecological screening, but also a comprehensive examination of the genetic, endocrine, immunological and mental state of patients with such diagnosis, as well as the provision of specialized psychological assistance.

Author Biography

I.L. Kharun, P.L. Shupyk National Healthcare University of Ukraine, Kyiv

Graduate student, Department of Obstetrics, Gynecology and Reproductology

References

  1. Regan L, Rai R, Saravelos S, Li T-C. Royal College of Obstetricians and Gynaecologists. Recurrent Miscarriage: Green-top Guideline №. 17. BJOG. 2023;130(12):e9–e39. DOI: 10.1111/1471-0528.17515
  2. The ESHRE Guideline Group on RPL, Atik RB, Christiansen OB, et al. ESHRE guideline: recurrent pregnancy loss: an update in 2022. Hum Reprod Open. 2023 Mar 2;2023(1):hoad002. DOI: 10.1093/hropen/hoad002
  3. Toth B, Würfel W, Bohlmann M, et al. Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry Number 015/050). Geburtshilfe und Frauenheilkunde. 2018 Apr;78(4):364–81. DOI: 10.1055/a-0586-4568
  4. Hennessy M, Dennehy R, Meaney S, et al. Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review. Reprod Biomed Online. 2021 Jun;42(6):1146–71. DOI: 10.1016/j. rbmo.2021.02.014
  5. Shargorodska E, Melenchuk L. Miscarriage: a modern view. Actual Problems of the Modern Medicine: Bulletin of Ukrainian Medical Stomatological Academy. 2022; Sept 22(2):116–21. DOI: 10.31718/2077-1096.22.2.116.
  6. Zharovska I, M. Blikhar R, Matkivska O, et al. Current Global Threats to the Reproductive Health of the Nation: Literature Review. Reproductive endocrinology. 2024 Jun;72:8–16. DOI: 10.18370/2309-4117.2024.72.8-16.
  7. Khan NT, Saadat M. Prevalence of Post-Traumatic Stress Disorder (PTSD) in Women After Miscarriage in Quetta City. J Women Health Care Gynecol. 2024. 3(5). DOI: 10.59657/2993-0871.brs.24.044
  8. Białek KI, Malmur M. Risk of post-traumatic stress disorder in women after miscarriage. Medical Studies/Studia Medyczne. 2020; 36(2):134–141. DOI:10.5114/ms.2020.96794.
  9. Bilardi JE, Temple-Smith M. We know all too well the significant psychological impact of miscarriage and recurrent miscarriage: so where is the support? Fertil Steril. August 2023 Nov;120(5):937–9. DOI: 10.1016/j.fertnstert.2023.08.951
  10. Kukulskienė M, Žemaitienė N. Postnatal depression and post-traumatic stress risk following miscarriage. International journal of environmental research and public health. 2022 May 27;19(11):6515. DOI:10.3390/ijerph19116515
  11. Farren J, Jalmbrant M, Falconieri N, et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study. Am J Obstet Gynecol. 2020 Apr;222(4):367.e1-367.e22. DOI: 10.1016/j.ajog.2019.10.102
  12. Shatkovska AS, Hryhorenko AP, Horbatiuk OH. Stress-induced disorders to the hypothalamic-hypophysal and peripheral endocrine systems in a woman’s body. Med Asp Wom Health. 2021;4(139):23–7.
  13. Tatarchuk T, Yefimenko O, Myronenko O, Mnevets R. Consequences of Wartime Stress on women’s Reproductive Health. Reproductive endocrinology. 2024 June;72:28–34. DOI: 10.18370/2309-4117.2024.72.28-34.
  14. Koert E, Malling GMH, Sylvest R, et al. Recurrent pregnancy loss: couples’ perspectives on their need for treatment, support and follow up. Hum Reprod. 2019 Feb 1;34(2):291–296. DOI:10.1093/humrep/dey362
  15. Mergl R, Quaatz SM, Lemke V, Allgaier A-K. Prevalence of depression and depressive symptoms in women with previous miscarriages or stillbirths – A systematic review. J Psychiatr Res. 2024 Jan:169:84-96. DOI: 10.1016/j.jpsychires.2023.11.021.
  16. Mishchenko VP, MishchenkoVV, Lavrinenko AL, et al. Pathogenetic justification of the algorithm of preparation for pregnancy of future parents with habitual miscarriage in anamnesis of women. Actual Problems of Pediatrics, Obstetrics and Gynecology. 2021 Sep;1:115–22. DOI: 10.11603/24116-4944.2021.1.12366
  17. Fartushok T, Shvab K, Shchudlik S. Prevention of miscarriage under stress during martial law. Grail of Science. 2023;25:475–88. DOI: 10.36074/grail-of-science.17.03.2023.082
  18. Order of the Ministry of Health of Ukraine dated 15.07.2011 №. 417 “On the organization of outpatient obstetric and gynecological care in Ukraine”. [Internet] Ministry of Health of Ukraine 2011. Available from: https://zakon. rada.gov.ua/rada/show/v0417282-11#Text
  19. Order of the Ministry of Health of Ukraine of 03.11.2008. № 624 “On Amendments to the Order of the Ministry of Health of Ukraine of December 15, 2003”. Clinical protocol “Miscarriage”. [Internet] Ministry of Health of Ukraine 2008. Available from: https://zakon.rada.gov.ua/rada/show/v0624282-08#Text
  20. PCL – PTSD self-assessment scale [Internet]. Available from: https://i-cbt.org.ua/wp-content/uploads/2017/11/PCL_ПТСР.pdf
  21. Rozov V.I. Psychology of extreme situations: adaptability to stress and psychological support: a scientific and practical guide. Kyiv: KNT, 2024. Beck Hopelessness Scale; р. 687.
  22. Order of the Ministry of Health of Ukraine of 23.02.2016 № 121 “Unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care. “Response to severe stress and adaptation disorders. Post-traumatic stress disorder”. [Internet] Ministry of Health of Ukraine 2008. Available from: https://dec.gov. ua/wpcontent/uploads/images/dodatki/2016_121_ PTSR/2016_121_YKPMD_PTSRpdf?fbclid=IwAR067y DcA17RTxg67qO3m5jk6gnQmaS5HAe49cy0WzBggEciV hmhD_hTg7k
  23. Chen J, Yue J, Lu Y, et al. Recurrent miscarriage and low-titer antiphospholipid antibodies. Clin Rheumatol. 2024:43;1327–34. DOI:10.1007/s10067-023-06843-x
  24. Kennedy RL, Malabu UH, Jarrod G, et al. Thyroid function and pregnancy: before, during and beyond. J Obstet Gynaecol. 2010;30:774–83. DOI:10.3109/01443615.2010.517331.
  25. Romanenko I. Relationship of Hormonal Profile and Anxiety Disorders in women – Internally Displaced Persons With Threatened Miscarriage. International journal of endocrinology (Ukraine). 2020 Jun;16(4):316–21. DOI:10.22141/2224-0721.16.4.2020.208484.
  26. Voss P, Schick M, Langer L, et al. Recurrent pregnancy loss: a shared stressor-couple-orientated psychological research findings. Fertil Steril. 2020;114(6): 1288–96. DOI: 10.1016/j.fertnstert.2020.08.1421

Downloads

Published

2024-11-29

How to Cite

Kharun, I. (2024). Assessment of the risks of recurrent pregnancy loss in patients with post-traumatic stress disorder. REPRODUCTIVE ENDOCRINOLOGY, (74), 48–54. https://doi.org/10.18370/2309-4117.2024.74.48-54

Issue

No. 74 (2024)

Section

Pregnancy and childbirth

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

    1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

    1. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.