Impact of magnesium deficiency on perinatal outcomes in patients with and without connective tissue dysplasia

Ilyina I.Yu., Chikisheva A.A., Dobrokhotova Yu.E.

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, Russia
Connective tissue dysplasia (CTD) is one of the discussed topics. Female patients with CTD are at risk for pregnancy and childbirth complications: threatened miscarriage, preeclampsia, placental insufficiency, and surgical delivery.
Objective. To improve perinatal outcomes with consideration for collagen metabolism in the presence of hypomagnesemia.
Subjects and methods. A total of 155 pregnant women were examined and divided into 2 groups according to the presence or absence of CTD signs. Group 1 included 58 (37.4%) pregnant women with non-syndromic CTD (nCTD). Group 2 consisted of 97 (62.6%) pregnant women who had no signs of CTD manifestations. Each group of the pregnant women was divided into 2 subgroups according to the presence or absence of magnesium deficiency.
Results. The investigation revealed that the lower plasma magnesium level in pregnant women substantially worsens the prognosis of pregnancy and childbirth. Correction of magnesium status during pregnancy is ineffective. It is necessary to determine magnesium levels before pregnancy and to timely implement therapeutic and preventive measures including the correction of magnesium deficiency in the patients with nCTD and in those with a family obstetric history; whereas the drugs improving collagen metabolism should be prescribed for the patients with nCTD. This category of patients should plan a pregnancy when they reach the standard magnesium values and the normalized levels of biochemical markers of collagen breakdown, which can considerably improve perinatal outcomes. Thus, there may be more common threatened miscarriage and a high risk for perinatal losses in the patients with nCTD versus pregnant women with normal plasma magnesium levels and normal collagen breakdown values. Threatened miscarriage, preterm delivery, premature amniorrhea, abnormal uterine contractions, and surgical delivery more frequently happen in the pregnant women without nCTD and with magnesium deficiency than in those with normal plasma magnesium levels and normal collagen breakdown values.
Conclusion. Thus, optimal methods for the diagnosis and prevention of complications in pregnant women with hypomagnesemia in the presence or absence of CTD were developed on the basis of assessment of the results of standard and special studies, including the determination of the levels of blood magnesium, collagen breakdown markers (urinary deoxypyridinoline and glycosaminoglycans and blood fibronectin).

Keywords

connective tissue dysplasia
magnesium
magnesium deficiency
hypomagnesemia
perinatal outcomes
threatened miscarriage

References

  1. Ильина И.Ю., Доброхотова Ю.Э., Жданова М.С. Влияние дисплазии соединительной ткани на развитие пролапса гениталий. Российский вестник акушера-гинеколога. 2009; 9(4): 15-8. [Ilyina I.Yu., Dobroxotova Yu.E., Zhdanova M.S. The effect of connective tissue dysplasia on the development of genital prolapse. Russian Bulletin of the obstetrician-gynecologist. 2009; 9(4): 15-8. (in Russian)].
  2. Garcia-Gonzаlez M., Rodríguez-Lozano B., Bustabad S., Ferraz-Amaro I. Undifferentiated connective tissue disease: predictors of evolution into defi nitedisease. Clin. Exp. Rheumatol. 2017; 35(5): 739-45.
  3. Веропотвелян П.Н., Цехмистренко И.С., Веропотвелян Н.П., Гацелюк С.В. Стратегический взгляд на факторы риска пролапса гениталий и способы их коррекции. Медицинские аспекты здоровья женщины. 2016; 3: 66-74. [Veropotvelyan P.N., Cexmistrenko I.S., Veropotvelyan N.P., Gacelyuk S.V. A strategic view of the risk factors for genital prolapse and how to correct them. Medical aspects of women's health. 2016; 3(100): 66-74. (in Russian)].
  4. Щербинина Н.А., Алайя Ламиа. Факторы риска возникновения пролапса гениталий у женщин в перименопаузе с дисплазией соединительной ткани и их коррекция. Вестник проблем биологии и медицины. 2016; 1(2): 135-9. [Shherbinina N.A., Alajya Lamia. Risk factors for genital prolapse in perimenopausal women with connective tissue dysplasia and their correction. Bulletin of problems of biology and medicine. 2016; 1(2): 135-9. (in Russian)].
  5. Gazit Y., Jacob G., Grahame R. Ehlers-Danlos syndrome-hypermobility type: a much neglected multisystemic disorder. Rambam Maimonides Med. J. 2016; 7(4): e0034.: https://dx.doi.org/10.5041/RMMJ.10261.
  6. Meester J.N., Verstraeten A., Schepers D., Alaerts M., Van Laer L., Loeys B.L. Differences in manifestations of Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. Ann. Cardiothorac. Surg. 2017; 6(6): 582-94. https://dx.doi.org/10.21037/acs.2017.11.03.
  7. Мартынов А.И., Нечаева Г.И., Акатова Е.В., Вершинина М.В., Викторова И.А.,Громова О.А., Дрокина О.В., Друк И.В., Дубилей Г.С., Ильиных А.А.,Кудинова Е.Г., Лисиченко О.В., Логинова Е.Н., Лялюкова Е.А., Нагаева Т.А., Надей Е.В., Плотникова О.В., Пономарева Д.А., Семенкин А.А., Смольнова Т.Ю. и др. Национальные рекомендации Российского научного медицинского общества терапевтов по диагностике, лечению и реабилитации пациентов с дисплазиями соединительной ткани. Медицинский вестник Северного Кавказа. 2016; 11(1): 2-76. [Akatova E.V., Vershinina I.A.,Viktorova I.A., Gromova O.A. et al. National recommendations of the Russian scientific medical society of therapists for the diagnosis, treatment and rehabilitation of patients with connective tissue dysplasia. Medical Bulletin of the North Caucasus. 2016; 1: 2-41. (in Russian)].
  8. Национальные рекомендации Российского научного медицинского общества терапевтов по диагностике, лечению и реабилитации пациентов с дисплазиями соединительной ткани. 2015; 75. [National recommendations of the Russian scientific medical society of therapists for the diagnosis, treatment and rehabilitation of patients with connective tissue dysplasia. 2015; 75. (in Russian)].см. №7
  9. Друк И.В., Рождественский А.С., Бождественский А.С., Смяловский В.Э., Гальцова Л.Г., Логинова Е.Н., Корсаков М.В. Церебральный сосудистый синдром дисплазии соединительной ткани как причина субарахноидальных кровоизлияний у пациентов молодого возраста. Журнал невропатологии и психиатрии им. С.С. Корсакова. 2018; 118(12-2): 15-22. [Druk I.V.,Rozhdestvensky A.S., Smyalovsky D.V. et al. Cerebral vascular syndrome of connective tissue dysplasia as a cause of subarachnoid hemorrhage in young patients. Zh Nevrol Psikhiatr Im S S Korsakova. 2018; 118(12-2): 15-22. In Russian).]
  10. Hao Y., Feng L., Teng Y., Cheng Y., Feng J. Management of multiple neurological complications in mixed connective tissuedisease: A case report. Medicine (Baltimore). 2018; 97(31): e11360. https://dx.doi.org/10.1097/MD.0000000000011360.
  11. Тарабанова О.В., Крутова В.А., Ордокова А.А., Харитонова И.А., Мизина Ю.С., Федак С.В. Лабораторные и иммуногистохимические предикторы рецидива пролапса гениталий. Сеченовский вестник. 2017; 4: 42-50. [Tarabanova O.V., Krutova V.A., Ordokova A.A. et al. Laboratory and immunohistochemical predictors of recurrent genital prolapse. Sechenov Bulletin. 2017; 4(30): 42-50. (in Russian)].
  12. Фролов А.Л., Кулавский В.А., Никифорова М.В. Роль маркеров дисплазии соединительной ткани в развитии истмико-цервикальной недостаточности при беременности. Мать и дитя в Кузбассе. 2014; 3: 54-6. [Frolov A.L.,Kulavskij V.A., Nikiforova M.V. The role of markers of connective tissue dysplasia in the development of isthmic-cervical insufficiency during pregnancy. Mother and child in Kuzbass. 2014; 3(58): 54-6. (in Russian)].
  13. Eltayeb R., Rayis D.A., Sharif M.E., Ahmed A.B., Elhardello O., Adam I. The prevalence of serum magnesium and iron deficiency anaemia among Sudanese women in early pregnancy: a cross-sectional study. Trans. R. Soc. Trop. Med. Hyg. 2019; 113(1): 31-5. https://dx.doi.org/10.1093/trstmh/try109.
  14. Ahmadi S., Naderifar M., Samimi M., Mirhosseini N., Amirani E., Aghadavod E., Asemi Z. The effects of magnesium supplementation on gene expression related to inflammatory markers, vascular endothelial growth factor, and pregnancy outcomes in patients with gestational diabetes. Magnes. Res. 2018; 31(4): 131-42. https://dx.doi.org/10.1684/mrh.2019.0446.
  15. Керимкулова Н.В., Никифорова Н.В., Торшин И.Ю., Гоголева И.В., Волков А.Ю., Громова О.А. Беременность и роды у женщин с дисплазией соединительной ткани и железодефицитной анемией. Вопросы гинекологии, акушерства и перинатологии. 2014; 13(5): 11-21. [Kerimkulova N.V., Nikiforova N.V., Torshin I.Yu. et al. Pregnancy and childbirth in women with connective tissue dysplasia and iron deficiency anemia. Questions of gynecology, obstetrics and Perinatology. 2014; 13(5): 11-21. (in Russian)].
  16. Лукина Т.С., Павлов О.Г. Терапия препаратами магния при беременности у женщин с недифференцированной дисплазией соединительной ткани. Вестник новых медицинских технологий. Электронное издание. 2014; 1: 78. [Lukina T.S., Pavlov O.G. Therapy with magnesium preparations during pregnancy in women with undifferentiated connective tissue dysplasia. Bulletin of new medical technologies. Electronic edition. 2014; 1: 78. (in Russian)].
  17. Чайка В.К., Железная А.А., Лунева Н.Н. Ведение осложненной беременности у беременной с недифференцированной дисплазией соединительной ткани (клинический случай). Медико-социальные проблемы семьи. 2019; 24(1): 104-11. [Chajka V.K., Zheleznaya A.A., Luneva N.N. Management of complicated pregnancy in a pregnant woman with undifferentiated connective tissue dysplasia (clinical case). Medical and social problems of the family. 2019; 24(1): 104-11. (in Russian)].
  18. Калинин Р.Е., Сучков И.А., Пшенников А.С., Камаев А.А., Мжаванадзе Н.Д. Концентрация матриксных металлопротеиназ и ионов магния при варикозной болезни вен нижних конечностей. Ангиология и сосудистая хирургия. 2016; 22(4): 24-8. [Kalinin R.E, Suchkov I.A, Pshennikov A.S. et al. Concentration of matrix metalloproteinases and magnesium ions in patients with varicose veins of lower limbs. Angiol Sosud Khir. 2016; 22(4): 24-8. (in Russian)].
  19. Смольнова Т.Ю., Адамян Л.В. Критерии постановки диагноза дисплазии соединительной ткани у женщин. В кн.: Материалы I Всероссийской научно-практической конференции «Актуальные вопросы внутренней патологии. Дисплазия соединительной ткани». Омск; 2005: 156. [Smol'nova T.Yu., Adamyan L.V. Criteria for the diagnosis of connective tissue dysplasia in women. In: Proceedings of the I All-Russian scientific and practical conference "Topical issues of internal pathology. Connective tissue dysplasia". Omsk. 2005; 156. (in Russian)].
  20. Громова О.А., Калачева А.Г., Торшин И.Ю., Грустливая У.Е., Прозорова Н.В., Егорова Е.Ю., Гришина Т.Р., Суханова Т.Ю., Белинская А.Ю. О диагностике дефицита магния. Часть 1. Архивъ внутренней медицины. 2014; 2: 5-11. [Gromova O.A., Kalacheva A.G., Torshin I.Yu.et al. About the diagnosis of magnesium. Part 1. Archive of internal medicine. 2014; 2(16): 5-11. (in Russian)].
  21. Кадурина Т.И. Горбунова В.Н. Дисплазия соединительной ткани. Руководство для врачей. СПб.: "Медкнига"ЭЛБИ"; 2009: 576-626. [Kadurina T.I. Gorbunova V.N. Connective tissue dysplasia. Saint-Petersburg; 2009: 576-626. (in Russian)].

Received 30.11.2020

Accepted 13.01.2021

About the Authors

Irina Yu. Ilyina, N.I. Pirogov RNRMU HPE SEI, Therapeutical Faculty, Obstetrics and Gynecology Department. Tel: +7(495)722-63-99. E-mail: iliyina@mail.ru.
ORCID: 0000-0001-8155-8775. 117513, Russia, Moscow, Ostrovitianov str., 1/9.
Ayshe A. Chikisheva, N.I. Pirogov RNRMU HPE SEI, Therapeutical Faculty, Obstetrics and Gynecology Department. Tel: +7(495)722-63-99. E-mail: aishe007@mail.ru.
ORCID: 0000-0003-4934-4501. 117513, Russia, Moscow, Ostrovitianov str., 1/9.
Yulia E. Dobrokhotova, N.I. Pirogov RNRMU HPE SEI, Therapeutical Faculty, Obstetrics and Gynecology Department. Tel: +7(495)722-63-99. E-mail: pr.dobrohotova@mail.ru. ORCID: 0000-0002-7830-2290. 117513, Russia, Moscow, Ostrovitianov str., 1/9.

For citation: Ilyina I.Yu., Chikisheva A.A., Dobrokhotova Yu.E. Impact of magnesium deficiency on perinatal outcomes in patients with and without connective tissue dysplasia.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 1: 140-46 (in Russian).
https://dx.doi.org/10.18565/aig.2021.1.140-46

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