PECTIN THERAPY IS A METHOD OF PREVENTION OF REPRODUCTIVE LOSSES ASSOCIATED WITH INTRAPLACENTARY ACCUMULATION OF RADIONUCLIDES
Authors: Zhyvetska- Denysova A. , Vorobiova I. , Skrypchenko N. , Lozova L. , Shamaieva O. , Rudakova N. , Stryzhak S. 
Published: December 2024

To date, environmental factors play a decisive role in the pathogenesis of miscarriage. The ecology of Ukraine suffered due to the accident at the Chornobyl NPP, which has no analogs in terms of the number of radionuclides that entered the environment, the area affected, and the consequences. In modern conditions, people are exposed to radioactive substances through food. Among the 200 radionuclides that have entered the environment, 137Cs represent the greatest danger in the long term due to soil and water contamination. Internal radiation is one of the causes of reproductive losses. The accumulation of 137Cs in the placenta disrupts its architecture, functionality, and peroxide hemostasis. Detox defects due to 137Cs require correction to prevent reproductive losses.
Aim of the study: to determine the effectiveness of pectin therapy in preventing reproductive losses associated with the incorporation of 137Cs into the placenta.
Materials and methods. According to the study design, the first (research) group included 153 women with reproductive losses in anamnesis and signs of termination of the current pregnancy; the second (control) group included 30 women with an uncomplicated history and pregnancy. The article is based on the results of past studies, which relate to the peculiarities of the functioning of the detox system in the event of miscarriage due to the accumulation of 137Cs in the placenta. We found a connection between the redox processes, pregnancy scenarios, and 137Cs activity in the placenta. Taking into account that one cause of miscarriage is the reaction of the placenta to 137Cs, measures preventing reproductive losses included “Apple Pectin Antioxidant” ("APА") with high sorption potential. The effectiveness of therapy was evaluated by dividing pregnant women into subgroups: 1A - without "APА" and 1B - with "APА". The criteria for treatment effectiveness were indicators of antioxidant protection and pregnancy scenarios.
Statistical data analysis was performed using Microsoft Excel (2016) and Fisher angular transformation. The difference between comparative values was considered significant at p < 0.05 (probability index greater than 95%).
Permission to conduct research was obtained from the Medical Ethics Committee of the SI “Institute of Pediatrics, Obstetrics, and Gynecology named academic Elena M. Lukyanova of the National Аcademy of Мedical Sciences of Ukraine” (protocol No 3 of 07.06.2017).
Scientific research work: "Develop the latest and improve existing technologies for diagnosis, prevention, and treatment of premature termination of pregnancy in women with miscarriage taking into account the passport of the placenta" (2018-2020). Code VN.20.00.02.18, state registration number 0118U000039, KPKV 6561040.
Research results. It has been established that internal irradiation with incorporated radiocesium disrupts the architecture and functional capacity of the placenta. Accumulation in the placenta up to 1.0 Bq/kg of 137Cs does not affect the course of pregnancy. The compensatory capacity of the placenta remains preserved with the accumulation of 1.1 to 4.4 Bq/kg of 137Cs. Internal irradiation with an activity of 4.5-10.4 Bq/kg 137Cs damages the maternal stroma of the placenta and premature birth at 28-36+ 6 weeks. As a result of the accumulation of more than 10.4 Bq/kg of 137Cs, maternal and fetal structures of the placenta are damaged, which leads to early premature birth and antenatal death of the fetus.
The biochemical amplifier of the radiation effect is the activation of lipid peroxidation (LPO). Malondialdehyde is an indicator of LPO activation. An increase in the content of MDA in blood in the 1st trimester by 8.7% against the reference values is acceptable. An increase in MDA by 17.4% is a trigger for late preterm labor. An increase in MDA by 23.4% indicates a high probability of early preterm birth. Superoxide dismutase is a powerful antioxidant capable of neutralizing POL products. A manifestation of oxidative stress and a trigger for premature birth is a decrease in the activity of SOD in the blood by more than 11.1% against the reference values. Decreased activity of SOD  in the blood in 2nd trimester by 26.3% indicates decompensation of antioxidant protection, which leads to early premature birth and antenatal fetal loss.
Conclusions. It is impossible to develop optimal measures for the treatment and prevention of miscarriage with universal effectiveness due to the multifactorial nature of pathology. Using "APА" as part of the pathogenetic therapy of miscarriage allows you to count on its high efficiency. The effectiveness of "APA" is explained by the minimization of the radiation effect on the placenta due to the accelerated removal of 137Cs while maintaining the functional capacity of the placenta. Against the background of "APF", there is a decrease in the deficiency of SOD and the excess of MDA in the blood, an increase in the number of timely births by 27.9%, and a decrease in cases of premature births by 11.4%, and spontaneous abortions by 11.0%, and halt develop of the embryo by 5.5 %. Thanks to "APА" it was possible to get rid of early preterm births, which led to a 0.9% increase in the frequency of late preterm births. At the same time, the minimum gestation age for premature births has been increased to 34 weeks, which improves the prospects of newborns. It is advisable to prescribe "APА" from the pre-gravid period and during pregnancy to all women, regardless of the region of residence.