The role of endothelial dysfunction correction in comprehensive prevention of hypertensive complications of pregnancy
Authors:   SI Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of the NAMS of Ukraine, Kyiv, Davydova Iu.V. , Lymanska A.Yu. ,   SI Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of the NAMS of Ukraine, Kyiv,   Bogomolets National Medical University, Kyiv, Ukraine
Published: February 2024

Purpose - to study the effect of correction of endothelial dysfunction by the introduction of L-arginine in the comprehensive prevention of the development of severe hypertensive disorders in pregnant women. Materials and methods. The division into groups was carried out indiscriminately following the prescribed bath. 27 women reached the 1st group, who, in addition to basic prevention of preeclampsia (small doses of aspirin for 12 days, calcium supplement 1000 mg per dose for 16 years), took Tivortin until conception and p. It's an hour of urgency; up to the 2nd group - 54 women who did not receive basic prevention of preeclampsia. The control group (3) consisted of 16 healthy women with physiological changes in vagusity. Participants of the 1st group, during the hour of stay in the hospital, took L-arginine internally (iv) (4 g) + 2 teaspoons 2 times (4 g) per os per dose 40 minutes before admission, then 3 teaspoons spoons 2 times (6 g per dose). The average intensity of the droplets became 6. The function of the endothelium was evaluated according to the universally recognized non-invasive cuff test method, which is based on the principle of ultrasound assessment of the change in the diameter of the brachial artery in response to the restoration of blood flow in it after short-term compression of the upper limb with a cuff. Physical condition and endurance were assessed using the generally accepted 6-minute walk method. The quality of life in pregnant women who had experienced severe preeclampsia in the past was assessed in stages - according to the health-related quality of life (HRQoL) scale and the scale created by the World Health Organization (WHOQOL-BREF). Results. Arterial hypertension and preeclampsia are based on changes in endothelium-dependent vasodilatation. A positive effect on the function of the endothelium significantly improves indicators of physical well-being and quality of life. When conducting a test with a 6-minute walk in the Group 1, better indicators were found than in the Group 2 (respectively, 409±23 m vs. 381±32 m, p<0.05), this indicator in the control group was 473±32 m (p<0.05 according to the Groups 1 and 2). However, this indicator significantly improved in pregnant women of the Group 1 after intravenous administration of L-arginine: 441±12 m (p<0.05 compared to the indicator before intravenous administration). According to the assessment of the quality of life of pregnant women of the studied groups, it should be noted that the quality of life indicators in all domains are significantly lower in women of the Group 1, which is associated with significantly worse anamnesis data of such women, significant concern about the results of the next pregnancy. When evaluating indicators of endothelium-dependent and endothelium-independent vasodilatation, it was found that in the group of women who received L-arginine preconceptionally, in the 1st trimester, the indicator before intravenous IV administration was 5.09±0.44, and after - 8.21±0.24, which indicates a significant improvement in endothelium-dependent vasodilation indicators (by 49.1%) 28-32 weeks, there are also no births of children with a body weight of less than 1500 g. Conclusions. In the group of high-risk pregnant women, the use of L-arginine in the complex prevention of preeclampsia allows to reduce the risks of early severe preeclampsia, to reduce the medication burden of two- and three-component hypotensive therapy. An increase in physical endurance, quality of life, and improvement in pregnancy outcomes are due to a positive effect on the function of the endothelium through the optimization of endothelium-dependent vasodilatation associated with the provision of the L-arginine substrate for the full synthesis of nitric oxide. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.