CLINICAL AND PATHOGENETIC RATIONALE FOR THE USE OF MAGNESIUM PREPARATIONS IN PREGNANT WOMEN WITH ISTHMIC CERVICAL INSUFFICIENCY AND UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA
Objective. To provide a clinical and pathogenetic rationale for obstetric management tactics for pregnant women with isthmic cervical insufficiency (ICI) and undifferentiated connective tissue dysplasia (UCTD) on the basis of complex studies, including molecular biological ones. Subjects and methods. A retrospective analysis of delivery records was made in 532 women and a prospective series of studies was conducted in 140 women with ICI of varying genesis. Genotyping was carried out using polymerase chain reaction; a biochemical study of the levels of magnesium was made in peripheral blood and saliva; the peripheral blood concentrations of matrix metalloproteinases were measured by enzyme immunoassay. Results. The most common markers of UCTD were tall stature, varicosity, mitral valve prolapse, myopia, and neurocirculatory dystonia. Various gestational complications, poor pregnancy outcomes, complicated labor, and birth of premature babies were more frequently noted in groups of pregnant women with functional ICI and those with ICI of mixed genesis. The clinical and laboratory patterns of magnesium deficiency were found in all groups of the examinees, the most pronounced magnesium deficiency being in the pregnant women with ICI of functional genesis. Study of HLA class I showed that the frequency of HLA-B35 antigen was significantly increased as compared to the general population. The significantly higher frequency of the A allele of the ESR-2014 G > A gene (OR 6.57, 95% CI 1.96—22.02), detected in pregnant women with the prolapsed fetal bladder, suggests that carriage of the A allele of the ESR-2014 G>A gene is a risk factor for threatening premature labor. Conclusion. A detailed analysis of the data obtained on ICI-UCTD relationships could confirm the contribution of UCTD to the development of a variety of obstetric complications and define ICI as a visceral marker of UCTD. The findings will promote obstetric alertness and rational management tactics for pregnant women with UCTD.