Efficacy of using progesterone as an immunosuppressant for the prevention of preeclampsia in pregnant women with iron-deficiency anemia

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Abstract

BACKGROUND: In previous studies, our data on the activation of pro-inflammatory cytokines at the systemic and local levels indicated an inadequate maternal immune response to fetal egg antigens against the backdrop of endocrine system restructuring and iron-deficiency anemia, which is a fundamental mechanism underlying the pathogenesis of preeclampsia. The above was the basis for the use of immunotherapy at a high risk of developing preeclampsia in pregnant women.

AIM: The aim of this study was to evaluate the use of micronized progesterone as an immunosuppressant for the prevention of preeclampsia in pregnant women with iron-deficiency anemia.

MATERIALS AND METHODS: We examined 44 pregnant women with iron-deficiency anemia in dynamics by trimesters of pregnancy: patients before and after taking micronized progesterone (main group, n = 25) and untreated pregnant women (comparison group, n = 19). We used general clinical and laboratory methods, assessing serum progesterone levels at 4–6, 25–28 and 32–36 weeks of pregnancy before and after the treatment, as well as statistical methods using evidence-based medicine approaches.

RESULTS: Taking micronized progesterone in pregnant women with iron-deficiency anemia from early gestation increased blood progesterone level by 1.5 times by 28 weeks of pregnancy (p < 0.05) and by 2.5 times by 32–34 weeks of pregnancy (p < 0.05) compared to that in women who did not take the hormonal drug. In case of progesterone deficiency in pregnant women with iron-deficiency anemia and mild preeclampsia, the administration of micronized progesterone elevated its blood level by 2.4 times (p < 0.05), but in severe preeclampsia in untreated women, the hormone concentrations were reduced. In women with iron-deficiency anemia, due to the inclusion of progestogen in standard antianemic therapy from early stages and throughout pregnancy, the incidence of severe preeclampsia and preterm birth was decreased in 93.3% of cases, which led to a live birth in most cases.

CONCLUSIONS: Micronized progesterone in pregnant women may be used to correct progesterone deficiency conditions, one of which is iron-deficiency anemia, and, as an immunosuppressant, to protect the fetus from an aggressive maternal immune response, manifested by the development of preeclampsia and other complications. The use of the gestagen therapy from early pregnancy is a promising tool for the prevention of preeclampsia in pregnant women with iron-deficiency anemia. Undoubtedly, further and more extensive research is needed to better understand this issue.

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About the authors

Yulduz K. Djabbarova

Tashkent Pediatric Medical Institute

Author for correspondence.
Email: ulduzjab43@mail.ru
ORCID iD: 0000-0002-3456-2381

MD, Dr. Sci. (Med.)

Uzbekistan, Tashkent

Shoira T. Ismoilova

Fergana Medical Institute of Public Health

Email: ismoilovasht7227@gmail.com

MD, Cand. Sci. (Med.)

Uzbekistan, Fergana

Shakhida T. Ziyaeva

Tashkent Pediatric Medical Institute

Email: shahida63@inbox.ru

MD, Cand. Sci. (Med.), Assistant Professor

Uzbekistan, Tashkent

Kamola T. Mirzaahmedova

Tashkent Pediatric Medical Institute

Email: komola.mirzaaxmedova@mail.ru
ORCID iD: 0000-0002-8703-8997

MD, Cand. Sci. (Med.), Assistant Professor

Uzbekistan, Tashkent

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2. Fig. 1. Serum progesterone levels in pregnant women with iron-deficiency anemia during treatment. IDA, iron-deficiency anemia; PE, preeclampsia. * p < 0.05, the difference is significant in relation to the indicator at 4–6 weeks gestation; ^ p < 0.05, the difference is significant in relation to the indicator at 26–28 weeks of gestation; # p < 0.05, the difference is significant in relation to all indicators at 32–34 weeks of gestation

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3. Fig. 2. Treatment related complications of pregnancy in women with iron-deficiency anemia. IDA, iron-deficiency anemia; PE, preeclampsia; PR, preterm birth; PANLP, premature abruption of a normally located placenta

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4. Fig. 3. Pregnancy outcomes in women with iron-deficiency anemia after the prophylactic gestagen therapy. IDA, iron-deficiency anemia; PE, preeclampsia. * p < 0.05, the difference is significant in relation to the same indicator in the group untreated patients with IDA II degree and severe preeclampsia

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5. Fig. 4. Data on newborns from mothers with iron deficiency anemia. ЖДА, iron-deficiency anemia; ПЭ, preeclampsia

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