Application of mathematical modeling for stratification of pregnant women by the risk of pathological lactogenesis
The aim of the study was to develop a gestational model for predicting the impairment of lactational function in pregnant women with placental insufficiency (PN) to justify the timely initiation of preventive therapy for early hypogalactia. Materials and methods. The formation of lactation function in the postpartum period was compared with the state of the fetoplacental complex during gestation in 90 women with PN of varying severity, which were divided into subgroups: A-subgroup comprised 48 women with placental dysfunction, B-subgroup - 42 women with severe PN forms. The control group included 40 healthy women with a physiological pregnancy. The complex analysis of the state of the fetoplacental complex and the completeness of gestational mammogenesis included instrumental (ultrasound, ultrasound, CTG) and laboratory methods (identification of markers of apoptosis, placental angiogenesis, decidualization and energy supply, placental lactogen). Results. The examined markers showed insufficiently high isolated prognostic value as predictors of early hypogalactia, which was confirmed by ROC analysis. However, placental and mammaric indices combined into a single complex formed the basis for the development of a predictive model by the method of multidimensional logistic regression. This model has a high enough informativeness (Se=69%, Sp=77%, with p<0.05) and allows stratifying pregnant women for the risk of pathological lactogenesis for timely initiation of measures for its correction. The conclusion. The laboratory-instrumental indicators included in the model are easy to analyze and economically acceptable, which makes this prognostic complex accessible to practical health care. Application of the developed model optimizes the natural feeding, which will favorably affect the health of young and older children.