We can assume a deterioration in the psychoemotional state and a decrease in the quality of life in women after assisted reproductive technologies (ART) with intrahepatic cholestasis of pregnancy (ICP), but no scientific information was found on this issue. The objective: to assess the psychoemotional state of pregnant women with ICP after using ART. Materials and methods. We examined 40 pregnant women after ART with the manifestations of ICP (main group) and 40 – without the manifestations of ICP (comparison group). The presence of vegetative dysfunction syndrome was assessed (according to A.M. Wayne); quality of sleep, especially falling asleep and waking up (A.M. Vein, Yu.I. Levin); anxiety level using the test Spielberg in the modification by Hanin, the presence and severity of depression on the Beck scale; quality of life according to the questionnaire SF-36. The data were processed by methods of variation statistics. Results. In pregnant women after ART with ICP, the total number of points on the A.M. Vein questionnaire is 3.5 times higher than the threshold value of 15 points (median 52 [45, 60] points versus 36 [28; 45] points in the absence of ICP, p<0.05). 80.0% of these women reported sleep disorders. The incidence of significant sleep quality disturbances is 37.5%. Patients demonstrate a higher median level of both personal and situational anxiety. Manifestations of depression were noted in 55.0% patients against 27.5% in the comparison group (p<0.05). Women with ICP have lower ratings for their quality of life, both on physical and psychological health scales. The decrease in the integral indicator of physical health (70 [58; 89] versus 84 [75; 92], p<0.05) is a reflection of the physical discomfort associated with ICP. Conclusions. After using ART, women with ICP need to assess the vegetative and psychoemotional state, correct the revealed disorders to normalize the quality of life, and achieve positive perinatal outcomes. Keywords: assisted reproductive technologies, intrahepatic cholestasis of pregnancy, vegetative dysfunction syndrome, anxiety, depression, quality of life.
Статьи, публикуемые в журнале «ЗДОРОВЬЕ ЖЕНЩИНЫ», -рецензированы. Ответственность за достоверность фактов и прочих сведений в публикациях несут авторы. Ответственность за содержание рекламы, а также за соответствие приводимых в рекламе сведений требованиям законодательства несут рекламодатели. Редакция и издатели не несут ответственности за достоверность информации, опубликованной в рекламных материалах. Мнение редакции может не совпадать с мнением авторов публикации. Перепечатка материалов только с письменного разрешения редакции. При перепечатке ссылка на журнал «ЗДОРОВЬЕ ЖЕНЩИНЫ» обязательна.
Failures of in vitro fertilization (IVF) may be associated with prothrombotic states, the circulation of antiphospholipid antibodies (APA). 93 women with infertility were screened: the first group 32 women without severe psychosomatic disorders; the second group 61 women with psychosomatic disorders. The control group consisted of 30 fertile women. We carried out measurements in the blood serum of the level of AFA to membrane phospholipids (phosphatidylethanolamine, phosphatidylserine, cardiolipinum), antibodies to β2-glycoprotein (Iβ2-GPI), hemostasis (platelet count, ADP-induced platelet aggregation index, fibrinogen concentration, prothrombin index, activated partial thromboplastin time APTT, test for soluble fibrin-monomeric complexes, D-dimer), homocysteine, molecular genetic study of polymorphous variants for β-fibrinogen (C148T, 455GA) genes. The frequency of significant AFA titres in the group of women without psychosomatic disorders was 18.9%, and in women with psychosomatic disorders 44.3%, the rate of β2-GPI 9.6% in the first group versus 24.5% in the second group. Only in 11.5% of women in the second group elevated levels of APA were associated with β2-GPI and/or one or more clinical criteria for antiphospholipid syndrome (APS). In patients with infertility and psychosomatic disorders, we found increased platelet aggregation in the context of relative thrombocytopenia, higher fibrinogen levels, soluble fibrin-monomeric complexes, and prolonged APTT with elevated D-dimer levels. Some patients had hyperhomocysteinemia. In patients with psychosomatic disorders, the frequency of the minor alleles of the locus C148T and 455GA of the β-fibrinogen gene was greater than 40% (25–30% in first group). We distinguished factors that adversely affect the efficiency of IVF in the patients with psychosomatic disorders: elevation of APA; reduction in the number of thrombocites; growth of the ADP-induced aggregation index; extension of APTT; increase of fibrinogen, D-dimer; homocysteine; the presence of the minor allele of the T polymorphic locus C148T of the β-fibrinogen gene. The presence of prothrombotic states associated with APS should be taken into account when preparing for IVF and the appropriate correction should be made for them.
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