Course of the pregnancy in women with connective tissue disorders
DOI: 10.32364/2618-8430-2020-3-3-182-188
I.Yu. Il’ina, A.A. Chikisheva
Pirogov Russian National Research Medical University, Moscow, Russian Federation
This paper discusses connective tissue disorders (CTD), in particular, undifferentiated connective tissue disease (UCTD) whose importance is accounted for by a high prevalence of this condition. Generalized connective tissue damage that involves reproductive system significantly affects the course of pregnancy and delivery. The complications of pregnancy, delivery, and postpartum period in women with UCTD which often require surgical procedures (i.e., amniotomy, episiotomy, perineotomy, C-section etc.) are described. The paper highlights the role of magnesium which is of crucial importance for the complex biosynthesis of extracellular matrix during connective tissue formation and fibroblast morphological functional status. The tests for connective tissue metabolic disorders (blood oxyproline and fibronectin, urine pyrilinks-D and glycosaminoglycans etc.) are addressed. Considering the lack of the reliable diagnostic (biochemical and genetic) criteria for UCTD, the authors advo cate the need for a complex examination using anamnestic data and the results of clinical, instrumental, and laboratory tests.
Keywords: connective tissue disorders, hemostasis, complications of pregnancy and delivery, magnesium deficiency, endothelial dysfunction, markers of collagen degradation, genital prolapse.
For citation: Il’ina I.Yu., Chikisheva A.A. Course of the pregnancy in women with connective tissue disorders. Russian Journal of Woman and Child Health. 2020;3(3):182–188. DOI: 10.32364/2618-8430-2020-3-3-182-188.
About the authors:
Irina Yu. Il’ina — Doct. of Sci. (Med.), professor of the Department of Obstetrics & Gynecology of the Medical Faculty, N.I. Pirogov Russian National Research Medical University, 1, Ostrovityanov str., Moscow, 117437, Russian Federation, ORCID iD 0000-0001-8155-8775.
Aishe A. Chikisheva — assistant of the Department of Obstetrics & Gynecology of the Medical Faculty, N.I. Pirogov Russian National Research Medical University, 1, Ostrovityanov str., Moscow, 117437, Russian Federation, ORCID iD 0000-0003-4934-4501.
Contact information: Irina Yu. Il’ina, e-mail: iliyina@mail.ru. Financial Disclosure: no authors have a financial or property interest in any material or method mentioned. There is no conflict of interests. Received 07.06.2020, revised 19.06.2020, accepted 03.07.2020.
References
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10. Torshin I. Yu., Gromova O.A. Connective tissue dysplasia, cell biology and molecular mechanisms of magnesium exposure. RMJ. 2008;16(4):230 (in Russ.).
11. Boudin E., van Hul W. Sclerosing bone dysplasias. Best Pract Res Clin Endocrinol Metab. 2018;32(5):707–723. DOI: 10.1016/j.beem.2018.06.003.
12. Martins K.F., Jarmy-DiBella Z.I., Fonseca A.M. et al. Evaluation of demographic, clinical characteristics and genetic polymorphism as risk factors for pelvic organ prolapse in Brazilian women. Neurourol Urodynam. 2011;30:1325–1328.
13. Perumal R.K., Perumal S., Thangam R. et al. ollagen-fucoidan blend film with the potential to induce fibroblast proliferation for regenerative applications. Int J Biol Macromol. 2018;106:1032–1040.
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20. Garcia-Gonzаlez M., Rodríguez-Lozano B., Bustabad S., Ferraz-Amaro I. Undifferentiated connective tissue disease: predictors of evolution into defi nitedisease. Clin Exp Rheumatol. 2017;35(5):739–745.
21. Khodzhayeva Z.S., Gurbanova S.R. Clinical and pathogenetic rationale for the use of magnesium preparations in pregnant women with isthmic cervical insufficiency and undifferentiated connective tissue dysplasia. Obstetrics and Gynecology (Moscow). 2011;3:57–63 (in Russ.).
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23. Barbagallo M., Belvedere M., Dominguez L.J. Magnesium homeostasis and aging. Magnesium Research. 2009;22(4):235–246.
24. Shankar H., Kumar N., Sandhir R. et al. Association of dietary intake below recommendations and micronutrient deficiencies during pregnancy and low birthweight. J Perinat Med. 2019;47(7):724–731. DOI: 10.1515/jpm-2019-0053.
25. Wallace E., Lowry J., Smith S.M., Fahey T. The epidemiology of malpractice claims in primary care: a systematic review. BMJ Open. 2013;3(7): e002929. DOI: 10.1136/bmjopen-2013-002929.
26. Chaika V.K., Zheleznaya A.A., Luneva N.N. Management of a complicated pregnancy in a pregnant woman with undifferentiated connective tissue dysplasia (clinical case). Medical and social problems of the family. 2019;24(1):104–111 (in Russ.).
27. Eltayeb R., Rayis D.A., Sharif M.E. et al. The prevalence of serum magnesium and iron deficiency anaemia among Sudanese women in early pregnancy: a cross-sectional study. Trans R Soc Trop Med Hyg. 2019;113(1):31–35. DOI: 10.1093/trstmh/try109.
28. Gracheva O.N., Gromova O.A. Connective tissue dysplasia during pregnancy: phenomenology, etiology, magnesium deficiency and molecular mechanisms. M.: Miklos; 2012 (in Russ.).
29. Zhabchenko I.A., Oleshko V.F. Peculiarities of pregnancy course and delivery, fetus and newborn condition in women with obstructive failure of cervix function. Okhrana materinstva i detstva. 2016;1(27):5–9 (in Russ.).
30. Zheleznaya A.A., Vustenko V.V., Mezhova O.K. The value of undifferentiated connective tissue dysplasia in obstetric and gynecological practice. Medical and social problems of the family. 2015;20(3–4):55–57 (in Russ.).
31. Anactasjeva V.G., Trunchenko N.V. Peculiarities of pregnancy development and confinement outcome in women with mitral valve prolapse. Bulletin of the East Siberian Scientific Center SB RAMS. 2007;3(55):18–22 (in Russ.).
32. Manuck T.A. The genomics of prematurity in an era of more precise clinical phenotyping: a review. Semin Fetal Neonatal Med. 2016;21(2):89–93. DOI: 10.1016/j.siny.2016.01.001.
33. Vink J., Feltovich H. Cervical etiology of spontaneous preterm birth. Semin Fetal Neonatal Med. 2016;21(2):106–112. DOI: 10.1016/j.siny.2015.12.009.
34. Komissarova L.M., Karachayeva A.N., Kesova M.I. The course of pregnancy and labor in connective tissue dysplasia. Obstetrics and Gynecology (Moscow). 2012;3:4–8 (in Russ.).
35. Kan N.E., Tyutyunnik V.L., Amiraslanov E.Yu. et al. Obstetric complications and undifferentiated connective tissue dysplasia. Clin Experiment Surg Petrovsky J. 2015;2:47–52 (in Russ.).
36. Kerimkulova N.V., Nikiforova N.V., Torshin I.Yu. Pregnancy and labour in women with connective tissue dysplasia and iron-deficiency anaemia. Gynecology, Obstetrics and Perinatology. 2014;13(5):11–21 (in Russ.).
37. Kononenko I.S., Zhukova N.P. Genetic predictors of cervical incompetence. Russian Bulletin of Obstetrician-Gynecologist. 2020;20(2):29–34 (in Russ.). DOI: 10.17116/rosakush20202002129.
38. Kravchenko E.N., Tyshkevich O.S. Diagnosis of undifferentiated forms of connective tissue dysplasia. News MANEB in the Omsk region. 2014;1(4):4–7 (in Russ.).
39. Kerchelaeva S.B., Kuznetsova O.V., Burdenko M.V. et al. Heart pathology and pregnancy: a study guide. M.; 2018 (in Russ.).
40. Kudinova E.G. Correction of changes in the hemostasis system in pregnant women with hereditary connective tissue disorders using vitamin-mineral complexes. Russian Journal of Woman and Child Health. 2014;22(19):1406–1411 (in Russ.).
41. Vagelli R., Tani C., Mosca M. Pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Practical messages from the EULAR guidelines. Pol Arch Intern Med. 2017;127(2):115–121. DOI: 10.20452/pamw.3906.
42. Watson S.P., Lowe G.C., Lordkipanidzé M., Morgan N.V. GAPP consortium. Genotyping and phenotyping of platelet function disorders. J. Thromb Haemost. 2013;11(Suppl. 1):351–363. DOI: 10.1111/jth.12199.
43. Stevens D.U., Al-Nasiry S., Bulten J., Spaanderman M.E.A. Decidual vasculopathy in preeclampsia: lesion characteristics relate to disease severity and perinatal outcome. Placenta. 2013;34(9):805–809. DOI: 10.1016/j.placenta.2013.05.008.
44. Smetnik V.P. Menopause medicine. M.: Litera; 2006 (in Russ.).
45. Tarabanova O.V., Krutova V.A., Ordokova A.A. et al. 0laboratorial and immunohistochemical predictors of recurrent genital prolapse. Sechenov Medical Journal. 2017;(4):42–50 (in Russ.).
46. Fadeeva T.S. Biochemical and clinical manifestations of connective tissue dysplasia in women with prolapse and prolapse of internal genital organs. Education and science in modern conditions. 2016;2–1(7):61–62 (in Russ.).
47. Joosten M.M., Gansevoort R.T., Mukamal K.J. et al. PREVEND Study Group. Urinary magnesium excretion and risk of hypertension: the prevention of renal and vascular end-stage disease study. Hypertension. 2013;61(6):1161–1167. DOI: 10.1161/HYPERTENSIONAHA.113.01333.
48. Karakov K.G., Elbekyan K.S., Markarova G.V. Fundamentals of biochemistry of tissues and organs of the oral cavity: a tutorial. Stavropol; 2012 (in Russ.).
49. Henkin R.I., Gouliouk V., Fordyce A. Distinguishing patients with glossopyrosis from those with oropyrosis based upon clinical differences and differences in saliva and erythrocyte magnesium. Arch. Oral Biol. 2012;57(2):205–210. DOI: 10.1016/j.archoralbio.2011.08.010.
50. Kalinin R.E., Suchkov I.A., Pshennikov A.S. et al. Concentration of matrix metalloproteinases and magnesium ions in patients with varicose veins of lower limbs. Angiol Sosud Khir. 2016;22(4):24–28 (in Russ.).
2. Nechaeva G.I., Viktorova I.A. Connective tissue dysplasia: terminology, diagnostics, patient management tactics. Omsk: BLANKOM;2007:11–47 (in Russ.).
3. National recommendations of the Russian scientific society of internal medicine for diagnostics, treatment and rehabilitation of patients with connective tissue dysplasia Medical news of north Caucasus. 2016;11(1):2–76 (in Russ.). DOI: 10.14300/mnnc.2016.11001.
4. Smolnova T. Yu., Adamyan L.V. Time course of changes in the phenotypic signs of connective tissue dysplasia at different ages: the urgency of the problem in obstetrics and gynecology. Obstetrics and Gynecology. 2013;4:74–79 (in Russ.).
5. Ilina I.Yu., Dobrohotova Yu.E., Zjdanova M.S. Optimization of the methods of the treatment, directed toward an improvement in the processes of collagen formation, in women with dysplasia of the connective tissue. Vestnik RUDN. Meditsina. 2009;5:76–82 (in Russ.).
6. Gazit Y., Jacob G., Grahame R. Ehlers-Danlos Syndrome-Hypermobility Type: A Much Neglected Multisystemic Disorder. Rambam Maimonides Med J. 2016;7(4).e0034. DOI: 10.5041/RMMJ.10261.
7. Kiss J., Balla B., Kоsa J.P. et al. Gene expression patterns in the bone tissue of women with fibrous dysplasia. Am J Med Genet A. 2010;152A (9):2211–2020. DOI: 10.1002/ajmg.a.33559.
8. Zoloto E.V. Connective tissue dysplasia — a problem in modern medicine. University Clinic. 2018;4(29):109–116. DOI: 10.26435/uc.v0i4 (29).252.
9. Nechaeva G.I., Yakovlev V.M., Konev V.P. et al. Dysplasia of connective tissue: the main clinical syndromes, the formulation of the diagnosis, treatment. Lechaschi Vrach J. 2008;2:22–28 (in Russ.).
10. Torshin I. Yu., Gromova O.A. Connective tissue dysplasia, cell biology and molecular mechanisms of magnesium exposure. RMJ. 2008;16(4):230 (in Russ.).
11. Boudin E., van Hul W. Sclerosing bone dysplasias. Best Pract Res Clin Endocrinol Metab. 2018;32(5):707–723. DOI: 10.1016/j.beem.2018.06.003.
12. Martins K.F., Jarmy-DiBella Z.I., Fonseca A.M. et al. Evaluation of demographic, clinical characteristics and genetic polymorphism as risk factors for pelvic organ prolapse in Brazilian women. Neurourol Urodynam. 2011;30:1325–1328.
13. Perumal R.K., Perumal S., Thangam R. et al. ollagen-fucoidan blend film with the potential to induce fibroblast proliferation for regenerative applications. Int J Biol Macromol. 2018;106:1032–1040.
14. Druk I.V., Rozhdestvensky A.S., Smyalovsky D.V. et al. Cerebral vascular syndrome of connective tissue dysplasia as a cause of subarachnoid hemorrhage in young patients. S.S. Korsakov Journal of Neurology and Psychiatry. 2018;118(12–2):15–22. DOI: 10.17116/jnevro201811812215.
15. Forlino A., Marini J.C. Osteogenesis imperfecta. Lancet. 2016;387(10028):1657–1671. DOI: 10.1016/S0140-6736 (15) 00728-X.
16. Marini J.C., Forlino A., Bächinger H.P. et al. Osteogenesis imperfecta. Nat Rev Dis Primers. 2017;18(3):17052. DOI: 10.1038/nrdp.2017.52.
17. Meester J.N., Verstraeten A., Schepers D. et al. Differences in manifestations of Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. Ann Cardiothorac Surg. 2017;6(6):582–594. DOI: 10.21037/acs.2017.11.03.
18. Veropotvelyan P.N., Tsekhmistrenko I.S., Veropotvelyan N.P., Gatselyuk S.V. A strategic look at risk factors for genital prolapse and how to correct them. Medical aspects of women’s health. 2016;3(100): 66–74 (in Russ.).
19. Shcherbinina N.A., Alaya Lamia. Risk factors for genital prolapse in perimenopausal women with connective tissue dysplasia and their correction. Bulletin of problems of biology and medicine. 2016;2(128):135–139 (in Russ.).
20. Garcia-Gonzаlez M., Rodríguez-Lozano B., Bustabad S., Ferraz-Amaro I. Undifferentiated connective tissue disease: predictors of evolution into defi nitedisease. Clin Exp Rheumatol. 2017;35(5):739–745.
21. Khodzhayeva Z.S., Gurbanova S.R. Clinical and pathogenetic rationale for the use of magnesium preparations in pregnant women with isthmic cervical insufficiency and undifferentiated connective tissue dysplasia. Obstetrics and Gynecology (Moscow). 2011;3:57–63 (in Russ.).
22. Shilov A.M., Melnik M.V., Sviridova A.U. Connective tissue dysplasia and magnesium deficiency. Farmateka. 2010;20:35–38 (in Russ.).
23. Barbagallo M., Belvedere M., Dominguez L.J. Magnesium homeostasis and aging. Magnesium Research. 2009;22(4):235–246.
24. Shankar H., Kumar N., Sandhir R. et al. Association of dietary intake below recommendations and micronutrient deficiencies during pregnancy and low birthweight. J Perinat Med. 2019;47(7):724–731. DOI: 10.1515/jpm-2019-0053.
25. Wallace E., Lowry J., Smith S.M., Fahey T. The epidemiology of malpractice claims in primary care: a systematic review. BMJ Open. 2013;3(7): e002929. DOI: 10.1136/bmjopen-2013-002929.
26. Chaika V.K., Zheleznaya A.A., Luneva N.N. Management of a complicated pregnancy in a pregnant woman with undifferentiated connective tissue dysplasia (clinical case). Medical and social problems of the family. 2019;24(1):104–111 (in Russ.).
27. Eltayeb R., Rayis D.A., Sharif M.E. et al. The prevalence of serum magnesium and iron deficiency anaemia among Sudanese women in early pregnancy: a cross-sectional study. Trans R Soc Trop Med Hyg. 2019;113(1):31–35. DOI: 10.1093/trstmh/try109.
28. Gracheva O.N., Gromova O.A. Connective tissue dysplasia during pregnancy: phenomenology, etiology, magnesium deficiency and molecular mechanisms. M.: Miklos; 2012 (in Russ.).
29. Zhabchenko I.A., Oleshko V.F. Peculiarities of pregnancy course and delivery, fetus and newborn condition in women with obstructive failure of cervix function. Okhrana materinstva i detstva. 2016;1(27):5–9 (in Russ.).
30. Zheleznaya A.A., Vustenko V.V., Mezhova O.K. The value of undifferentiated connective tissue dysplasia in obstetric and gynecological practice. Medical and social problems of the family. 2015;20(3–4):55–57 (in Russ.).
31. Anactasjeva V.G., Trunchenko N.V. Peculiarities of pregnancy development and confinement outcome in women with mitral valve prolapse. Bulletin of the East Siberian Scientific Center SB RAMS. 2007;3(55):18–22 (in Russ.).
32. Manuck T.A. The genomics of prematurity in an era of more precise clinical phenotyping: a review. Semin Fetal Neonatal Med. 2016;21(2):89–93. DOI: 10.1016/j.siny.2016.01.001.
33. Vink J., Feltovich H. Cervical etiology of spontaneous preterm birth. Semin Fetal Neonatal Med. 2016;21(2):106–112. DOI: 10.1016/j.siny.2015.12.009.
34. Komissarova L.M., Karachayeva A.N., Kesova M.I. The course of pregnancy and labor in connective tissue dysplasia. Obstetrics and Gynecology (Moscow). 2012;3:4–8 (in Russ.).
35. Kan N.E., Tyutyunnik V.L., Amiraslanov E.Yu. et al. Obstetric complications and undifferentiated connective tissue dysplasia. Clin Experiment Surg Petrovsky J. 2015;2:47–52 (in Russ.).
36. Kerimkulova N.V., Nikiforova N.V., Torshin I.Yu. Pregnancy and labour in women with connective tissue dysplasia and iron-deficiency anaemia. Gynecology, Obstetrics and Perinatology. 2014;13(5):11–21 (in Russ.).
37. Kononenko I.S., Zhukova N.P. Genetic predictors of cervical incompetence. Russian Bulletin of Obstetrician-Gynecologist. 2020;20(2):29–34 (in Russ.). DOI: 10.17116/rosakush20202002129.
38. Kravchenko E.N., Tyshkevich O.S. Diagnosis of undifferentiated forms of connective tissue dysplasia. News MANEB in the Omsk region. 2014;1(4):4–7 (in Russ.).
39. Kerchelaeva S.B., Kuznetsova O.V., Burdenko M.V. et al. Heart pathology and pregnancy: a study guide. M.; 2018 (in Russ.).
40. Kudinova E.G. Correction of changes in the hemostasis system in pregnant women with hereditary connective tissue disorders using vitamin-mineral complexes. Russian Journal of Woman and Child Health. 2014;22(19):1406–1411 (in Russ.).
41. Vagelli R., Tani C., Mosca M. Pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Practical messages from the EULAR guidelines. Pol Arch Intern Med. 2017;127(2):115–121. DOI: 10.20452/pamw.3906.
42. Watson S.P., Lowe G.C., Lordkipanidzé M., Morgan N.V. GAPP consortium. Genotyping and phenotyping of platelet function disorders. J. Thromb Haemost. 2013;11(Suppl. 1):351–363. DOI: 10.1111/jth.12199.
43. Stevens D.U., Al-Nasiry S., Bulten J., Spaanderman M.E.A. Decidual vasculopathy in preeclampsia: lesion characteristics relate to disease severity and perinatal outcome. Placenta. 2013;34(9):805–809. DOI: 10.1016/j.placenta.2013.05.008.
44. Smetnik V.P. Menopause medicine. M.: Litera; 2006 (in Russ.).
45. Tarabanova O.V., Krutova V.A., Ordokova A.A. et al. 0laboratorial and immunohistochemical predictors of recurrent genital prolapse. Sechenov Medical Journal. 2017;(4):42–50 (in Russ.).
46. Fadeeva T.S. Biochemical and clinical manifestations of connective tissue dysplasia in women with prolapse and prolapse of internal genital organs. Education and science in modern conditions. 2016;2–1(7):61–62 (in Russ.).
47. Joosten M.M., Gansevoort R.T., Mukamal K.J. et al. PREVEND Study Group. Urinary magnesium excretion and risk of hypertension: the prevention of renal and vascular end-stage disease study. Hypertension. 2013;61(6):1161–1167. DOI: 10.1161/HYPERTENSIONAHA.113.01333.
48. Karakov K.G., Elbekyan K.S., Markarova G.V. Fundamentals of biochemistry of tissues and organs of the oral cavity: a tutorial. Stavropol; 2012 (in Russ.).
49. Henkin R.I., Gouliouk V., Fordyce A. Distinguishing patients with glossopyrosis from those with oropyrosis based upon clinical differences and differences in saliva and erythrocyte magnesium. Arch. Oral Biol. 2012;57(2):205–210. DOI: 10.1016/j.archoralbio.2011.08.010.
50. Kalinin R.E., Suchkov I.A., Pshennikov A.S. et al. Concentration of matrix metalloproteinases and magnesium ions in patients with varicose veins of lower limbs. Angiol Sosud Khir. 2016;22(4):24–28 (in Russ.).
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