Features of hormonal status in pregnant women with cervical insufficiency, depending on the gender of the fetus being carried and their clinical significance
Authors:   Rostov State Medical University, Botasheva T.L. ,   Rostov-on-Don, Russian Federation, Keller O.V. ,   Rostov State Medical University; Rostov-on-Don, Russian Federation, Lebedenko E.Yu. ,   Rostov State Medical University; Rostov-on-Don, Russian Federation, Rymashevsky A.N. ,   Rostov State Medical University; Rostov-on-Don, Russian Federation, Zavodnov O.P. ,   Rostov State Medical University; Rostov-on-Don, Russian Federation, Gaida O.V. ,   Rostov State Medical University; Rostov-on-Don, Russian Federation
Published: January 2025

Infectious and inflammatory diseases of the cervix and congenital, genetically determined undifferentiated connective tissue dysplasia are considered to be among the most significant causes of the formation of the functional form of cervical insufficiency (CI), which determines the high percentage of premature births and the birth of premature babies. However, patients who meet these criteria do not always develop CI, which determines the search for new additional criteria for its prediction.
Objective. To study the features of the hormonal profile during pregnancy of fetuses of different sexes in patients with CI and uncomplicated gestation and their effect on the nature of the course of pregnancy and delivery outcomes.
Design. The retrospective-prospective study.
Materials and methods. The study of the incidence of CI in pregnant women with male and female fetuses, complications of pregnancy and childbirth was carried out by retrospective analysis of 41564 electronic outpatient charts of primiparous women with single pregnancy. As part of the prospective stage of the study, 1,629 women were examined, divided into two clinical groups: I (458 patients with the manifestation of the functional form of CI) and II (1171 women with physiological pregnancy (PhP). The sex of the fetus was determined by genetic analysis (in the I trimester) and ultrasound examination (in the II–III trimesters). Hormone levels (prolactin, placental lactogen, estriol, progesterone, adrenocorticotropic hormone (ACTH), cortisol, 17-OH-progesterone, thyroid-stimulating hormone), as well as urinary excretion of 6-sulfatoxymelatonin (6-SOMT) were carried out using enzyme immunoassay diagnostics.
Results. Statistically significant differences in the hormonal profile of women with CI and FB were revealed, in particular some hormones of the stress-liberating, steroid and placental subgroups. It was found that the absolute levels of 6-SOMT, cortisol and placental lactogen are significantly higher in mothers carrying female fetuses, whereas progesterone levels are higher in pregnant women with a male fetus, both with PhP and so it is with CI. The level of free estriol in PhP is significantly higher in patients carrying female fetuses, whereas in CI its indicators are higher in the case of the male fetus.
Conclusion. The results obtained on significant differences in the hormonal arrangement of gestational processes depending on the sex of the fetus allowed us to expand our understanding of the pathogenetic mechanisms of CI formation, to establish an additional risk factor for its development, which contributes to the development of individualized approaches to the prevention of premature birth occurring against the background of CI mainly in pregnant women with male fetuses within the framework of obstetric screening.
Keywords: cervical insufficiency, uncomplicated pregnancy, fetal sex, hormonal profile.