Prevalence of different types of psychological dominant during pregnancy at high obstetric and perinatal risk, obstetric complications in the context of psychosomatic relationships
Authors:   Ivano-Frankivsk National Medical University, Ukraine, Yakymchuk N.V. 
Published: June 2021

It is known that from the very beginning of pregnancy, many women notice changes in general health state which form the clinical manifestations of asthenic symptom-complex, that allows to assess these disorders as a «psychosomatic reaction to pregnancy». According to different authors, their frequency varies from 13.7 to 33.3%, their influence on the development of gestational complications has been revealed and proved, and the conducted test analysis demonstrates donozological changes in mental health in 73% of healthy pregnant women. The investigations that allow predicting the success of motherhood are very important, and it justifies the purpose of this scientific research. The objective: was to determine the structure and frequency of the types of psychological component of gestation dominant, affecting reproductive loss and complicated pregnancy rates in women at high obstetric and perinatal risk. Materials and methods. Experimental psycho-diagnostic research was conducted on the basis of the Centre of Conscious Parenthood «Diviia»» on a voluntary basis with women at different stages of pregnancy. The data of 840 patients, who had prenatal training in the Centre, were analysed and the types of psychological component of gestational dominant (PCGD) were determined using the clinical and psychological method of I.V. Dobriakov «Pregnant woman attitude test» with the following type definition of PCGD: optimal, hypogestognostic, euphoric, anxious, depressive. In parallel, with the aim of clarifying and obtaining more reliable data, psychodiagnostic «Dating Questionnaire» and projective drawing method «Me and My Child» by Filippova G.G. were carried out. Interpretation of the results was based on the features of the drawing, which allowed including self-perception of pregnancy and the unborn baby to a particular type. In the absence of the exact statements characterizing certain features of the PCGD, the combined variants (optimally anxious, optimally hypogestognostic) and mixed types were determined. Optimal type was generally considered a favourable one for the course of pregnancy (including optimally anxious, optimally hypogestognostic) and mixed types, while pure anxious, depressive, euphoric and hypogestognostic types were unfavourable. The statistical analysis was performed using the Stata 12 license pack with the odds ratio (OR) and 95% confidence interval for assessing the influence of factor features on the pathological course of pregnancy. Results. According to the results, the most popular type of PCGD was the optimal type (60.47%), it correlated with the most favourable course of pregnancy and childbirth. 352 patients (41.90%) belonged to unfavourable pure types of PCGD. The most substantial proportion among the unfavourable types of gestation dominant was the anxious type (58.81%), the hypogestognostic type was noted in 21.87%. In patients who had placental dysfunction and its complications during pregnancy, the prevalence of unfavourable types of PCGD that accompanied the entire gestational period was characteristic. The preponderance of pure anxious type (52.65%) and mixed types (47.34%) was noted. The depressive and euphoric type was mostly noted only in the mixed variant in approximately the same proportions – 9.09% and 10.23% of the observations, respectively. The evaluation of the nature of the course of pregnancy and childbirth in patients, considering the favourable or unfavourable type of gestation dominant, allowed to establish differences in the preterm birth frequency, resistance to treatment of preeclampsia and the proportion of abnormalities in labour and its drug correction. The pathological course of pregnancy and childbirth in women with unfavourable type of PCGD was 2.8 times more frequent, the percentage of operational delivery was 3.5 times higher than in patients with a favourable type of PCGD; gestoses of different severity – 2.6 times more often were diagnosed in patients with unfavourable types of PCGD. Placental dysfunction with objectified criteria for utero-placental blood flow disorders was 2.0 times more frequent, and in one third of cases, it was accompanied by negative effects on the fetus, in particular FFS and fetal distress during pregnancy. Conclusions. The evaluation of the structure of the types of the psychological component of the gestation dominant showed a high percentage of unfavourable types of PCGD (41.90%), as well as a statistically significant relationship between the peculiarities of the course of pregnancy and the births that have a close connection with the placental disorder, the gestational complications that accompany it (preeclampsia and fetal distress) and the progression of the disadaptation of utero-placental circulation. In the case of anxious type of PCGD diagnosis, the risk and progression of placental dysfunction increases by 7.27 times (OR – 7.27; 4.66–11.35) and requires psychological help at the preconception stage. The obtained results indicate the adequacy of the reserves to reduce the number of negative perinatal outcomes, including not only a precise assessment of obstetric and somatic anamnesis, and a comprehensive clinical and laboratory examination that allows to form high-risk groups, differentiate the psychological assistance to women and perform preventive measures and therapeutic care even at the stage of pregnancy planning. Key words: psychological component of gestation dominant, pregnancy, preeclampsia, placental dysfunction, prognosis.