Effect of maternal reproductive factors on prenatal screening rates in the first trimester

Effect of maternal factors on indicators of increased risk of chromosomal abnormalities (CA), pre-eclampsia (PE), Small-forGestational-Age Fetus (SGA fetus) and preterm labour and birth (PB) during prenatal screening has not been sufficiently studied.
Aim. To study the effect of maternal reproductive factors on the risk indicators of CA, PE, SGA fetus and PB, assessed during prenatal screening using the Astraia Obstetrics module.
Materials and methods. Of the 11,841 pregnant women who were prenatal screened, 18.53% of the patients had at high risk of the outcomes studied (frequency 1: 100 and above). The subgroup of isolated high risk for CA included 69, PE — 66, SGA fetus — 48, PB — 52 patients. From the group of patients with low risk, 208 patients were selected for the control group by the method of stratified randomization by age.
Results. Among extragenital diseases, the most common in all high-risk subgroups were: hypertension (AH) I and II degree — 31–47% versus 4.8% of the control group (p < 0.05), varicose veins of the lower extremities (VVLE) — 17–30% vs. 5.3% in the control group (p < 0.05), a history of ovarian tumor — 12–33% vs. 3% in the control group (p < 0.05). In the high-risk subgroups for the development of CA, PE and SGA fetus, fibroids uterus and iron deficiency anaemia (IDA) were more common compared to control: 10–41% vs. 1% (p < 0.05) and 10–17% vs. 3% (p < 0.05), respectively (p < 0.05). Primiparas with a history of pregnancy were more common in subgroups with a high risk of CA (33%) and PR (35%) versus 17% in controls.
Conclusion. An association has been established between high risk for all the outcomes studied and AC, VVLE, history of ovarian tumor. High-risk subgroups for CA, PE and SGA fetus have a higher incidence of uterine fibroids and IDA compared to control.

1. 1 Livrinova V., Petrov I., Samardziski I., et al. Clinical importance of low level of PAPP-a in first trimester of pregnancy — an obstetrical dilemma in chromomally normal fetus. 2019; 7(9): 1475–79. https://doi.org/10.3889/oamjms.2019.384 PMID: 31198458

2. 2 Akusherstvo: Natsional’noe rukovodstvo. Pod red. G.M. Savel’evoi, G.T. Sukhikh, V.N. Serova, V.E. Radzinskogo. [Obstetrics: National guidance.] Moscow: GEOTAR-Media. 2019; 1080 (In Russian).

3. 3 Radzinskii V. E. Akusherskaya agressiya, v. 2.0. [Obstetric aggression, v. 2.0.] Moscow: StatusPraesens. 2017; 872 (In Russian).

4. 4 Usta I.M., Zoorob D., Abu-Musa A., et al. Obstetric outcome of teenage pregnancies compared with adult pregnancies. 2008; 87(2): 178–83. https://doi.org/10.1080/00016340701803282 PMID: 18231885

5. 5 Ciancimino L., Laganà A.S., Chiofalo B., et al. Would it be too late? A retrospective case-control analysis to evaluate maternalfetal outcomes in advanced maternal age. 2014; 290(6): 1109–14. https://doi.org/10.1007/s00404-014-3367-5 PMID: 25027820

6. 6 Langley S. A Nutrition Screening Form for Female Infertility Patients. 2014; 75(4): 195–201. https://doi.org/10.3148/cjdpr-2014-024 PMID: 26067073

7. 7 Diagnostika i lechenie serdechno-sosudistykh zabolevanii pri beremennosti 2018. Natsional’nye rekomendatsii. [Diagnosis and treatment of cardiovascular diseases during pregnancy 2018. National Guidelines. Developed by the Committee of experts of the Russian society of cardiology (RSC). Section of cardiovascular diseases in pregnant women]. Russ J Cardiol. 2018; 3 (155): 91–134 (In Russian). http://dx.doi.org/10.15829/1560-4071-2018-3-91-134

8. 8 Stuklov N.I. Zhelezodefitsitnaya anemiya v praktike ginekologa. Algoritmy diagnostiki, profilaktiki i lecheniya. [Iron-deficiency anemia in the practice of a gynecologist. Algorithms for diagnosis, prevention, and treatment.] The Journal Obstetrics and Gynecology. 2016; 7: 99–104 (In Russian). http://doi.org/10.18565/aig.2016.7.99-104

9. 9 Farkash E., Weintraub A.Y., Sergienko R., et al. Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes. Eur J Obstet Gynecol Reprod Biol. 2012; 162(1): 24–7. https://doi.org/10.1016/j.ejogrb.2012.01.024 PMID: 22381037

10. 10 Matuszkiewicz-Rowińska J., Małyszko J., Wieliczko M. Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems. Arch Med Sci. 2015; 11(1): 67–77. https://doi.org/10.5114/aoms.2013.39202 PMID: 25861291

11. 11 Mason E., Chandra-Mouli V., Baltag V., et al. Preconception care: advancing from ‘important to do and can be done’ to ‘is being done and is making a difference’. Reproductive health. 2014; 11 (Suppl 3): S8. https://doi.org/10.1186/1742-4755-11-S3-S8 PMID: 25415261

12. 12 Dean S.V., Imam A.M., Lassi Z.S., Bhutta Z.A. Importance of intervening in the preconception period to impact pregnancy outcomes. 2013; 74: 63–73. https://doi.org/10.1159/000348402 PMID: 23887104

13. 13 Dean S.V., Lassi Z.S., Imam A.M., Bhutta Z.A. Preconception care: closing the gap in the continuum of care to accelerate improvements in maternal, newborn and child health. Reprod Health. 2014; 11(Suppl 3): S1. https://doi.org/10.1186/1742-4755-11-S3-S1 PMID: 25414942

14. 14 Tikhomirov A.L., Sarsaniya S.I. Problema zhelezodefitsitnoi anemii u zhenshchin: puti resheniya. [The problem of iron-deficiency anemia in women: solutions.] Russian Journal of Woman and Child Health. 2020; 1: 44–50 (In Russian). https://doi.org/10.32364/2618-8430-2020-3-1-44-50

15. 15 O’Gorman N., Wright D., Poon L.C., et al. Accuracy of competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks’ gestation. Ultrasound Obstet Gynecol. 2017 Jun; 49(6): 751–5. https://doi.org/10.1002/uog.17399 PMID: 28067011

16. 16 Panaitescu A.M., Baschat A.A., Akolekar R., et al. Association of chronic hypertension with birth of small-for-gestational-age neonate. Ultrasound Obstet Gynecol. 2017 Sep; 50(3): 361–6. https://doi.org/10.1002/uog.17553 PMID: 28636133

17. 17 Panaitescu A. M., Syngelaki A., Prodan N., et al. Chronic hypertension and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol. 2017 Aug; 50(2): 228–35. https://doi.org/10.1002/uog.17493 PMID: 28436175

18. 18 Beznoshchenko G.B., Kravchenko E.N., Tsukanov Yu.T., et al. Varikoznaya bolezn’ u beremennykh: osobennosti gestatsionnogo perioda, flebogemodinamika malogo taza i nizhnikh konechnostei. [Varicose veins in pregnant women: Specific features of a gestational period, phlebohemodynamics of the small pelvis and lower limbs]. Russian Bulletin of Obstetrician-Gynecologist. 2016; 16(3): 4–8 (In Russian). https://doi.org/10.17116/rosakush20161634-8

19. 19 Cordina M., Marianna S., Fernandez M., et al. Maternal hemoglobin at 27-29 weeks’ gestation and severity of pre-eclampsia. J Matern Fetal Neonatal Med. 2015 Sep; 28(13): 1575–80. https://doi.org/10.3109/14767058.2014.961006 PMID: 25184521