Prognostic factors for the development of congenital malformations after previous intrauterine fetal malformations
Abstract
Despite the huge burden of congenital malformations (CM), there are not enough studies characterizing the development of congenital malformations of the fetus in women with a burdened obstetric history. The aim is to identify and study the factors associated with fetal CM among women with a history of intrauterine malformation. Material and methods. The study included 665 women who had children with congenital malformations. Variables were considered: age, region, childbirth, number of pregnancies, number of abortions, miscarriages, fetal malformations, antenatal fetal death, methylenetetrahydrofolate reductase (MHTR) levels, alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated NE) and the frequency of HLA-II class antigens. Results. A history of intrauterine malformation was observed in 450 (67.7%) patients. According to the OR value, the high risk of fetal CM is associated with the early gestational period (OR = 191.02, 95% CI: 11.82-3085.9, p <0.05), the presence of various variants of HLA alleles (OR = 11.69, 95% CI: 2.73-50.01, p <0.05), DQA1 allele (OR = 6.78, 95% CI: 2.72-16.92, p <0.05), preterm birth factor (OR = 4.04, 95% CI: 2.69-5.07, p <0.05). The ROC curve of pregnancy and intrauterine malformation was 0.613 and 1.000, respectively. There is a statistically significant relationship between the formation of CM and variables: childbirth, gestational period, intrauterine malformation, recurrent miscarriage, antenatal mortality, antenatal mortality factor, MHTR polymorphism, HLA alleles.
Conclusion. Based on the study, the probable determinants influencing the development of CM were identified. The created logistic model had a high sensitivity and specificity, which makes it possible to offer it for use in clinical practice.
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