Role of antioxidant defense disorders during intrahepatic cholestasis of pregnant women and development of gestational complications

To date, the mechanisms of the onset of gestational complications in intrahepatic cholestasis of pregnant women (VCB) are not fully understood, and clear predictors of their development are not known. Oxidative stress and antioxidant defense disorders, which are a pathogenetic link in various pathologies of pregnancy, can play a role in the development of complications of pregnancy in VCB and serve as a prognostic marker for their occurrence. Purpose of the study. Determination of the role of antioxidant status disorders in the development of complications of pregnancy in patients with VCB. Materials of the study. A prospective study included 97 pregnant women who had VCB. Of these, a group of 57 patients was randomly selected. Patients of the isolated group underwent clinical and laboratory examination with determination of biochemical markers of damage to liver function, ultrasound. Antioxidant status was assessed on the basis of the determination of the content of antioxidant defense enzymes (superoxide dismutase [SOD], glutathione peroxidase [GTP]) and their coenzymes (zinc, selenium). Severe pruritus was established in the range from 0 to 3 initially (with the detection of VCB), and after 1 and 2 weeks of treatment. The treatment was carried out with ursodeoxycholic acid preparations at a dose of 500 mg to 2 g per day. Results. in patients with VCB who had complications of pregnancy (preterm delivery, intrauterine fetal hypoxia, preeclampsia, the need for caesarean section), lower levels of SOD, GTP, selenium and zinc were observed compared to patients who did not have these complications. Factors contributing to the disturbance of antioxidant protection in patients with VCB were its early onset and prolonged course, multiple pregnancies, the use of assisted reproductive technologies and sex hormone drugs, the presence of biliary sludge and the low efficacy of treatment of pruritus. The conclusion. The depletion of protective mechanisms that inhibit the development of oxidative stress is one of the links in the pathogenesis of complications of pregnancy in patients with VCB. Disorders of antioxidant protection in VCB can be considered as a predictor of the development of pregnancy complications and an indication for active management of patients.

intrahepatic cholestasis of pregnancy, oxidative stress, enzymes of antioxidant defense, glutathione peroxidase, superoxide dismutase, selenium, gestational complications

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