Features of anemia in pregnant women of various genesis in ethnic samples

Objective of the Study: to determine in different ethnic samples of pregnant women with anemia of various genesis the factors influencing on its development; perinatal outcomes in anemia of various genesis; features of the production of pro- and antioxidant blood factors.

Material and methods

A prospective cohort study of pregnant women with IDA and ACD was carried out in various ethnic samples. In the Republic of Dagestan, the sample with anemia consisted of 470 women: with IDA (n = 286) and ACD (n = 184). In the sample of pregnant women with anemia in the Republic of Sakha (Yakutia) (n = 284) we also distinguished groups with IDA (n = 186) and ACD (n=98). The control group - 34 healthy pregnant women in the Dagestan population and 42 – in the Yakut one was introduced into the study to compare the indicators in the study of pro- and antioxidant factors.

Research methods included the assessment of a general blood test, serum iron (SI), C-reactive protein (CRP), ferritin, total protein, pro- and antioxidant factors (erythrocyte and blood serum catalase, sulfhydryl groups (SH-groups), ceruloplasmin (CP) and malondialdehyde (MDA) in blood serum), the level of IgG to parasitic infections.

Results

The study showed a variety of risk factors and conditions contributing to the development of anemia on the background of lower iron and lower hemoglobin concentration in various ethnic samples (ecological, biological and social biotopes). True ID was confirmed at low levels of ferritin (100.0%) and serum iron.

Inflammatory diseases of the pelvic organs were twice as common in women with ACD than IDA (p <0.05).

Iron limiting participation for erythropoiesis in ACD was accompanied by an increase (85.6%) or normal serum ferritin level (14.4%), increase in the level of CRP (100,0%), lymphocytes (29.3%), monocytes (22.8%), blood sedimentation rate (ESR)(14.7%).

Pregnant women with true ID were characterized by a balanced increase in the level of pro- and antioxidant factors.

Iron metabolism violations in ACD were accompanied by a pronounced imbalance in the production of hydroperoxides and antioxidant protection factors.

The effect of excess lipid peroxidation products on the placenta in ACD in the Yakut population was accompanied by an evolutionarily accumulated level of endogenous antioxidants (blood plasma and erythrocyte catalase, sulfhydryl groups). A decrease in the compensatory mechanisms of the placenta of pregnant Dagestan women with ACD influenced the higher frequency of morphological and functional immaturity of newborns due to the moderate antioxidant potential.

Morphofunctional immaturity of newborns (MFI) in the group with ACD was detected one and a half times more often in the Dagestan population (p = 0.0005) than in the Yakut population (p = 0.04). Cerebral ischemia was more common among newborns from mothers with ACD – 1.8 times (p = 0.002) and 1.7 times (p = 0.04) than those with IDA in the sample of Dagestan and Yakut women, respectively.

Conclusion. It is shown necessity of correction of risk factors of anemia of different genesis at the preconception stage (replenishment of ID, essential micronutrients, treatment of infections and inflammatory diseases) to improve the hematological status of the mother and pregnancy outcomes.

The nature of placental dysfunction in anaemia of pregnant women is explained by the degree of severity of oxidative stress and the activity of compensatory-adaptive mechanisms. Iron metabolism violation in ACD is accompanied by excessive production of hydroperoxides, a certain decrease in the antioxidant potential in the Dagestan population in comparison with the Yakut population.

Anemia in the population of the Far North proceeds on the background of evolutionary adaptive and homeostatic physiological characteristics of the organism. The increased risk of adverse pregnancy outcomes (low birth weight, cerebral ischemia) was more common in women with ACD.

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