Hyperandrogenism as a risk factor for isthmicocervical insufficiency


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Abstract

This literature review analyzes the factors that explain failures in the prediction, timely diagnosis, treatment, and prevention of one of the most important obstetric problems, such as miscarriage. It presents an update on neonatal morbidity and mortality, which are due to prematurity as a result of preterm birth. Premature birth is considered as a complex multifactorial problem; the review underlines the importance of identifying risk factors for their development in different populations (body mass index calculation, weight gain during pregnancy, urinary steroid profile analysis, elastography, sociodemographic factors and others), which makes it possible to select appropriate preventive measures. Overproduction of androgens is a potentially significant risk factor for preterm birth. There is a review of modern literature sources, which reflects trend priorities in assessing the relationship between hyperandrogenism and isthmicocervical insufficiency. There is information on main risk factors for maternal hyperandrogenism, its impact on pregnancy complications, and fetal outcomes. Consideration is given to the trigger mechanisms of isthmicocervical insufficiency and the cofactors that determine its therapy; there are diverse opinions about the importance of hyperandrogenism of various geneses in the development of miscarriage and complicated pregnancy. Attention is focused on the direct cause-and-effect relationship between hyperandrogenism and the development of isthmicocervical insufficiency. Conclusion: The effectiveness of medical and surgical correction of isthmicocervical insufficiency is comparatively evaluated. Emphasis is laid on that the treatment policy for isthmicocervical insufficiency concurrent with hyperandrogenism should be differentiated and depends on many factors that today remain insufficiently studied in the world, by maintaining the risks of miscarriage.

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About the authors

Sergey A. Levakov

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: levakoff@yandexru
Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology of the NV. Sklifosovsky ICM

Artur V. Mokh

M.P. Konchalovsky City Clinical Hospital, Moscow Healthcare Department

obstetrician-gynecologist at the Maternity Department

Natalia A. Sheshukova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology of the NV. Sklifosovsky ICM

References

  1. Доброхотова Ю.Э., Козлов П.В., Мандрыкина Ж.А., Степанян А.В. Угроза прерывания беременности в различные сроки гестации. М.: ГЭОТАР-Медиа; 2016. 144с.
  2. Выкидыш в ранние сроки: диагностика и тактика ведения. Клинические рекомендации. Протокол лечения. М.; 2016. 32с.
  3. Карп Г.Дж.А., ред. Привычное невынашивание беременности: причины, версии и контраверсии, лечение. Пер. с англ. Радзинский В.Е., ред. М.: ГЭОТАР-Медиа; 2017. 592с. [Karp G.J.A., ed. Recurrent miscarriage: causes, versions and controversies, treatment. Translated from English, edited by V.E. Radzinsky. M.: GEOTAR-Media; 2017. 592 p. (in Russian).
  4. Atik R.B., Christiansen O.B., Elson J., Kolte A.M., Lewis S., Middeldorp S. et al.; ESHRE Guideline Group on RPL. ESHRE guideline: recurrent pregnancy loss. Hum. Reprod. Open. 2018; 2018(2): hoy004. https://dx.doi.org/10.1093/hropen/hoy004.
  5. Premature birth. Basic facts. WHO Fact Sheet, 19 February 2018. Available at: https://www.who.int/news-room/fact-sheets/detail/preterm-birth Accessed 23.06,2020.
  6. Chawanpaiboon S., Vogel J.P., Moller A.B., Lumbiganon P., Petzold M., Hogan D. et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob. Health. 2019; 7(1): e37-46. https://dx.doi.org/10.1016/S2214-109X(18)30451-0.
  7. Росстат. Данные Министерства здравоохранения Российской Федерации. Обновлено 28.11.2019. Доступно по: https://www.gks.ru/storage/mediabank/zdr3-2.xls Ссылка активна на: 23.06.2020.
  8. Luu T.M., Rehman Mian M.O., Nuyt A.M. Long-term impact of preterm birth: neurodevelopmental and physical health outcomes. Clin. Perinatol. 2017; 44(2): 305-14. https://dx.doi.org/10.1016/j.clp.2017.01.003.
  9. Raju T.N.K., Pemberton V.L., Saigal S., Blaisdell C.J., Moxey-Mims M., Buist S. Long-term healthcare outcomes of preterm birth: an executive summary of a conference sponsored by the National Institutes of Health. J. Pediatr. 2017; 181: 309-18. https://dx.doi.org/10.1016/j.jpeds.2016.10.015.
  10. Liu L., Oza S., Hogan D., Chu Y., Perin J., Zhu J. et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the sustainable development goals. Lancet. 2016; 388(10063): 3027-35. https://dx.doi.org/10.1016/S0140-6736(16)31593-8.
  11. Practice Bulletin No. 159: management of preterm labor. Obstet. Gynecol. 2016; 127(1): e29-38. https://dx.doi.org/10.1097/AOG.0000000000001265.
  12. Министерство здравоохранения Российской Федерации. Истмико-цервикальная недостаточность. Клинические рекомендации. Протокол лечения. М.; 2018. 42с.
  13. ACOG Practice Bulletin No. 142: Cerclage for the management of cervical insufficiency. American College of Obstetricians and Gynecologists. Obstet. Gynecol. 2014; 123(2, Pt 1): 372-9. https://dx.doi.org/10.1097/01.AOG.0000443276.68274.cc.
  14. RCOG. Cervical Cerclage. Green-top Guideline No. 60. 2011. 21p.
  15. Brown R., Gagnon R., Delisle M.F. No. 373-cervical insufficiency and cervical cerclage. J. Obstet. Gynaecol. Can. 2019; 41(2): 233-47. https://dx.doi.org/10.1016/j.jogc.2018.08.009.
  16. Withanawasam N., Tara S. The shortened cervix in pregnancy: investigation and current management recommendations for primary caregivers. Aust. J. Gen. Pract. 2019; 48(3): 121-3. https://dx.doi.org/10.31128/AJGP-09-18-4708.
  17. Diagnosis and Management of Cervical Insufficiency GLM0055. Maternity Guidelines Group Christchurch Women’s Hospital. New Zealand; 2017. 8р.
  18. South Australian Perinatal Practice Guidelines. Cervical insufficiency and cerclage. 2017. 13р.
  19. Thakur M., Mahajan K. Cervical incompetence. [Updated 2019 Dec 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. Available at: https://www.ncbi.nlm.nih.gov/books/NBK525954 Accessed 23.06.2020.
  20. Crum Ch., Lee K., Nucci M., Granter S., Howitt B., Parast M. et al. Diagnostic gynecologic and obstetric pathology. Elsevier; 2017. 1296p.
  21. Lu C., Lim B., Robson S.J. Increasing incidence rate of cervical cerclage in pregnancy in Australia: A population-based study. Healthcare (Basel). 2016; 4(3): pii: E68. https://dx.doi.org/10.3390/healthcare4030068.
  22. Preterm labour and birth overview. NICEPathways. 2020. 13р. Available at: http://pathways.nice.org.uk/pathways/preterm-labour-and-birth Accessed 23.06.2020.
  23. Шалина Р.И. Коррекция истмико-цервикальной недостаточности. Акушерство и гинекология: новости, мнения, обучение. 2015; 1: 40-3.
  24. Mossa F., Latham K.E., Ireland J.J., Veiga-Lopez A. Undernutrition and hyperandrogenism during pregnancy: Role in programming of cardiovascular disease and infertility. Mol. Reprod. Dev. 2019; 86(9): 1255-64. https://dx.doi.org/10.1002/mrd.23239.
  25. Makieva S., Saunders P.T.K., Norman J.E. Androgens in pregnancy: roles in parturition. Hum. Reprod. Update. 2014; 20(4): 542-59. https://dx.doi.org/10.1093/humupd/dmu008.
  26. Fornes R., Maliqueo M., Hu M., Hadi L., Jimenez-Andrade J.M., Ebefors K. et al. The effect of androgen excess on maternal metabolism, placental function and fetal growth in obese dams. Sci. Rep. 2017; 7(1): 8066. https://dx.doi.org/10.1038/s41598-017-08559-w.
  27. Kumar S., Gordon G., Abbott D., Mishra J. Androgens in maternal vascular and placental function: implications for preeclampsia pathogenesis. Reproduction. 2018; 156(5): R155-67. https://dx.doi.org/10.1530/REP-18-0278.
  28. Sherman Sh. B., Sarsour N., Salehi M., Schroering A., Mell B., Joe B., Hill J.W. Prenatal androgen exposure causes hypertension and gut microbiota dysbiosis. Gut Microbes. 2018; 9(5): 400-21.https://dx.doi.org/10.1080/19490976.2018.1441664.
  29. Hu M., Zhang Y., Guo X., Jia W., Liu G., Zhang J. et al. Hyperandrogenism and insulin resistance induce gravid uterine defects in association with mitochondrial dysfunction and aberrant reactive oxygen species production. Am. J. Physiol. Endocrinol. Metab. 2019; 316(5): E794-809. https://dx.doi.org/10.1152/ajpendo.00359.2018.
  30. Синдром поликистозных яичников в репродуктивном возрасте (современные подходы к диагностике и лечению). Клинические рекомендации (протокол лечения). М.; 2015. 22с.
  31. Fauser B.C., Tarlatzis В.С., Rebar R.W., Legro R.S., Balen A.H., Lobo R. et al. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil. Steril. 2012; 97(1): 28-38.e25. https://dx.doi.org/10.1016/j.fertnstert.2011.09.024.
  32. Palomba S., de Wilde M.A., Falbo A., Koster M.P., La Sala G.B., Fauser B.C. Pregnancy complications in women with polycystic ovary syndrome. Hum. Reprod. Update. 2015; 21(5): 575-92. https://dx.doi.org/10.1093/humupd/dmv029.
  33. Hakim Ch., Padmanabhan V., Vyas A.K. Gestational hyperandrogenism in developmental programming. Endocrinology. 2017; 158(2): 199-212. https://dx.doi.org/10.1210/en.2016-1801.
  34. Доброхотова Ю.Э., Рагимова З.Э., Ильина И.Ю., Ибрагимова Д.М. Гиперандрогения и репродуктивное здоровье женщины. М.: ГЭОТАР-Медиа; 2015. 144с.
  35. Yang C., Wang H., Zou Y., Cui W., Yang J., Li T. et al. Hyperreactio luteinalis after delivery: a case report and literature review. Int. J. Clin. Exp. Med. 2015; 8(4): 6346-8.
  36. Wang Y., Gu X., Tao L., Zhao Y. Co-morbidity of cervical incompetence with polycystic ovarian syndrome (PCOS) negatively impacts prognosis: A retrospective analysis of 178 patients. BMC Pregnancy Childbirth. 2016; 16(1): 308.
  37. Kandeel M.S., Sanad Z.F., Sayyed T.M., Elyazid Elmenawy S.A. The effect of body mass index on cervical characteristics and on the length of gestation in low-risk pregnancies. Menoufia Med. J. 2014; 27(3): 518-23. https://dx.doi.org/10.4103/1110-2098.145499.
  38. Prodromidou A., Frountzas M., Perrea D., Vlachos G.D., Pergialiotis V. The impact of obesity on cervical cerclage efficacy: A systematic review of the literature. J. Neonatal Perinatal Med. 2016; 9(1): 59-65. https://dx.doi.org/10.3233/ NPM-16915058.
  39. Amabebe E., Chapman D.R., Stern V.L., Stafford G., Anumba D.O.C. Mid-gestational changes in cervicovaginal fluid cytokine levels in asymptomatic pregnant women are predictive markers of inflammation-associated spontaneous preterm birth. J. Reprod. Immunol. 2018; 126: 1-10. https://dx.doi.org/10.1016/j.jri.2018.01.001.
  40. Zaher Y.A., Al-Kholy A.F. Cervicovaginal inflammatory cytokines, obesity and inter-pregnancy interval negatively affect pregnancy duration in pregnant women at high-risk for recurrent spontaneous preterm birth. Adv. Reprod. Sci. 2019; 7: 125-37. https://dx.doi.org/10.4236/arsci.2019.74014.
  41. Venkatesh K.K., Cantonwine D.E., Zera C., Arjona M., Smith N.A., Robinson J.N., McElrath T.F. Is there an association between body mass index and cervical length? Implications for obesity and cervical length management in pregnancy. Am. J. Perinatol. 2017; 34(6): 568-75. https://dx.doi.org/10.1055/s-0036-1594242.
  42. Gill L., Morgan E.A., Yamamura Y. Obesity and cerclage efficacy [33H]. Obstet. Gynecol. 2018; 131: 95S. https://dx.doi.org/10.1097/01.AOG.0000533420.87579.1e.
  43. Курцер М.А., Азиев О.В., Панин А.В., Егикян Н.М., Болдина Е.Б., Грабовская А.А. Лапароскопический серкляж при истмико-цервикальной недостаточности, вызванной ранее перенесенными операциями на шейке матки. Акушерство и гинекология. 2017; 5: 58-62. https://dx.doi.org/10.18565/aig.2017.5.58-62.
  44. Доброхотова Ю.Э., Кузнецов П.А., Джохадзе Л.С., Константинова К.И. Коррекция истмико-цервикальной недостаточности при многоплодной беременности. Дискуссионные вопросы. Акушерство и гинекология. 2017; 11: 10-5. [Dobrokhotova Yu.E., Kuznetsov P.A., Dzhokhadze L.S., Konstantinova K.I. Correction of isthmic-cervical insufficiency in multiple pregnancy. Debating issues. Obstetrics and Gynecology. 2017; 11: 10-5. (in Russian)]. https://dx.doi.org/10.18565/aig.2017.11.10-15.
  45. Rottenstreich A., Levin G., Kleinstern G., Zigron R., Rottenstreich M., Elchalal U., Yagel S. History-indicated cervical cerclage in management of twin pregnancy. Ultrasound Obstet. Gynecol. 2019; 54(4): 517-23. https://dx.doi.org/10.1002/uog.20192.
  46. Тетруашвили Н.К., Агаджанова А.А., Милушева А.К. Экстренный серкляж: показания, противопоказания, возможности медика ментозного лечения. Доктор.Ру. 2019; 11: 11-3.)]. [Tetruashvili N.K., Agadzhanova A.A., Milusheva A.K. Urgent cerclage: indications, contraindications, drug therapy. Doktor.Ru. 2019; 11(166): 11-3. (in Russian)]. https://dx.doi.org/10.31550/1727-2378-2019-166-11-11-13.
  47. Baumer A., Gimovsky A.C., Gallagher M., Leftwich M.C. A synthetic cervix model and the impact of softness on cerclage integrity. Interface Focus. 2019; 9(5): 20190009. https://dx.doi.org/10.1098/rsfs.2019.0009.
  48. Ильина И.Ю., Доброхотова Ю.Э., Юмина С.В. Гиперандрогения различного генеза и ее возможное влияние на коллагенообразование. Вестник Российского университета дружбы народов. Cерия: Медицина. 2009; 5: 224-31.
  49. Валиева М.С., Мухамадиева К.М., Исматуллоева С.С., Агафонова Е.В. Андрогензависимые дермопатии у женщин с келоидными рубцами. Вестник Авиценны. 2019; 21(3): 387-94. [Valieva M.S., Mukhamadieva K.M., Ismatulloeva S.S., Agafonova E.V. Androgen-dependent dermopathies in women with keloid scars. Vestnik Avisenny/Avicenna Bulletin. 2019; 21(3): 38794. (in Russian)]. https://dx.doi.org/10.25005/2074-0581-2019-21-3-387-394.
  50. Мартынов А.И., Нечаева Г.И., Акатова Е.В., Вершинина М.В., Викторова И.А., Громова О.А., Дрокина О.В., Друк И.В., Дубилей Г.С., Ильиных А.А., Кудинова Е.Г., Лисиченко О.В., Логинова Е.Н., Лялюкова Е.А., Нагаева Т.А., Надей Е.В., Плотникова О.В., Пономарева Д.А., Семенкин А.А., Смольнова Т.Ю. и др. Национальные рекомендации Российского научного медицинского общества терапевтов по диагностике, лечению и реабилитации пациентов с дисплазиями соединительной ткани. Медицинский вестник Северного Кавказа. 2016; 11(1): 2-76.
  51. Ильина И.Ю., Доброхотова Ю.Э., Чикишева А.А., Маликова В.О. Особенности иммунного статуса у пациенток с гормональными нарушениями и недифференцированными формами дисплазии соединительной ткани. РМЖ. Мать и дитя. 2019; 1: 23-7. [Ilyina I.Yu., Dobrokhotova Yu.E., Chikisheva A.A., Malikova V.O. Immune status characteristics in patients with hormonal disorders and hormonal disorders and undifferentiated connective tissue dysplasia. Mother and Child. Russian Medical Journal. 2019; 1: 23-7. (in Russian)]. https://dx.doi.org/10.32364/2618-8430-2019-2-1-23-27.
  52. Новикова В.А., Черепахин Е.П.,Глебова Е.В.,Никонов М.А., Томашевский Д.В. Возможности объективной оценки течения преждевременных родов в различные гестационные сроки. Акушерство и гинекология. 2018; 6: 25-30. [Novikova V.A., Cherepakhin E.P., Glebova E.V., Nikonov M.A., Tomashevsky D.V. Opportunities for an objective assessment of the course of preterm labor at various gestational ages. Obstetrics and Gynecology. 2018; 6: 25-30. (in Russian)]. https://dx.doi.org/10.18565/aig.2018.6.25-30.
  53. Berghella V., Saccone G. Cervical assessment by ultrasound for preventing preterm delivery. Cochrane Database Syst. Rev. 2019; (9): CD007235. https://dx.doi.org/10.1002/14651858.CD007235.pub4.
  54. Souza R. T., Costa M.L., Mayrink J., Feitosa F.E., Filho E.A.R., Leite D.F. et al.; The Preterm SAMBA study group. Clinical and epidemiological factors associated with spontaneous preterm birth: a multicentre cohort of low risk nulliparous women. Sci. Rep. 2020; 10(1): 855. https://dx.doi.org/10.1038/s41598-020-57810-4.
  55. Доброхотова Ю.Э., Боровкова Е.И., Залесская С.А., Нагайцева Е.А., Раба Д.П. Диагностика и тактика ведения пациенток с истмико-цервикальной недостаточностью. Гинекология. 2018; 20(2): 41-5. [Dobrokhotova Yu.E., Borovkova E.I., Zalesskaya S.A., Nagaitseva E.A., Raba D.P. Diagnosis and management patients with cervical insufficiency. Gynecology. 2018; 20(2): 41-5. (in Russian)]. https://dx.doi.org/10.26442/2079-5696_2018.2.41-45.
  56. Горячкина М.В., Потекаев Н.Н., Корсунская И.М., Дворянкова Е.В., Доброхотова Ю.Э., Рагимова З.Э., Джобава Э.М. Комплексный подход к обследованию пациенток с рефрактерным акне. В. кн.: Сборник тезисов II национального альянса дерматологов и косметологов. Ростов-на-Дону; 2008: 52-4.
  57. Рагимова З.Э., Джобава Э.М., Доброхотова Ю.Э., Горячкина М.В., Потекаев Н.Н. Гиперандрогения и акне: некоторые аспекты диагностики. В. кн.: Сборник материалов IV съезда акушеров-гинекологов России. Москва, 30 сентября-2 октября 2008 г. М.; 2008: 459.
  58. Шафигуллина З.Р., Великанова Л.И., Ворохобина Н.В., Лисицын А.А., Кухианидзе Е.А., Стрельникова Е.Г., Поваров В.Г., Тейлор Н.Ф. Диагностическое значение стероидных профилей биологических жидкостей у больных с синдромом Иценко-Кушинга. Проблемы эндокринологии. 2015; 61(4): 4-8. https://dx.doi.org/10.14341/probl20156144-8.
  59. Ворохобина Н.В., Татаринова М.В., Великанова Л.И., Серебрякова И.П., Малеваная Е.В., Галахова Р.К. Особенности метаболизма стероидных гормонов у женщин репродуктивного возраста с различными формами гиперандрогении. Вестник Северо-Западного государственного медицинского университета им. И.И. Мечникова. 2016; 8(3): 42-9.
  60. Medley N., Vogel J.P., Care A., Alfirevic Z. Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews. Cochrane Database Syst. Rev. 2018; (11): CD012505. https://dx.doi.org/10.1002/14651858.CD012505.pub2.
  61. Астраханцева М.М., Бреусенко Л.Е., Лебедев Е.В., Плеханова Е.Р., Савельева Г.М., Шалина Р.И. Истмико-цервикальная недостаточность. Диагностика и коррекция. Российский вестник акушера-гинеколога. 2016; 16(2): 83-8. [Astrakhantseva M.M., Breusenko L.E., Lebedev E.V., Plekhanova E.R., Savel'eva G.M., Shalina R.I. Isthmicocervical insufficiency: Diagnosis and correction. Russian Bulletin of Obstetrician-Gynecologist. 2016; 16(2): 83-8. (in Russian)]. https://dx.doi.org/10.17116/rosakush201616283-88.
  62. Conde-Agudelo A., Romero R., Da Fonseca E., O'Brien J.M., Cetingoz E., Creasy G.W. et al. Vaginal progesterone is as effective as cervical cerclage to prevent preterm birth in women with a singleton gestation, previous spontaneous preterm birth, and a short cervix: updated indirect comparison meta-analysis. Am. J. Obstet. Gynecol. 2018; 219(1): 10-25. https://dx.doi.org/10.1016/j.ajog.2018.03.028.
  63. Доброхотова Ю.Э., Бондаренко К.Р., Дворников А.С. Современные представления о воспалительных заболеваниях малого таза: обзор литературы. Гинекология. 2016; 18(3): 4-8.
  64. Kindinger L.M., Bennett P.R., Lee Y.S., Marchesi J.R., Smith A., Cacciatore S. et al. The interaction between vaginal microbiota, cervical length, and vaginal progesterone treatment for preterm birth risk. Microbiome. 2017; 5(1): 6. https://dx.doi.org/10.1186/s40168-016-0223-9.

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