Vol 8, No 3 (2021)

The purpose of this article is to provide a comprehensive overview of current knowledge about pregnancy and hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and current methods to reduce mother-to-child transmission (MTCT). Maternal infection with HBV or HCV is associated with complicated pregnancy and childbirth outcomes, including MTCT. In countries, including the United States, which introduced postpartum HBV vaccination and immunization with hepatitis B immunoglobulin, MTCT overall decreased to about 5%. However, with maternal HBV levels greater than 200,000 IU/ml, the transmission rate of HBV to neonates is almost 30%. For these patients, there are new recommendations from the European Association for the Study of the Liver (EASL), which indicate that, in addition to vaccination of newborns and their immunization, treatment with antiviral drugs such as tenofovir disoproxil fumarate or telbivudine, used during pregnancy, starting from 32 weeks is necessary, that are safe and effective in preventing mother-to-child transmission. Unlike HBV, no therapy is yet available or recommended to further reduce the risk of mother-to-child transmission of HCV infection, which remains by 3–10%. MTCT of HCV can be minimized by avoiding obstetrics and birth trauma if possible. Young women with HCV should be sent for treatment after delivery, and newborns should be closely monitored to rule out infection. Newer, better tolerated HCV regimens have become more available and should reduce the number of women and babies infected.

AIM: The study aimed to investigate and compare Doppler metric indicators in the main arteries of the functional system of the mother, placenta, and fetus as well as the parameters of the activity–rest cycle in fetuses with vascular endothelial growth factor (VEGF) expression and placenta growth factor (PlGF) in the presence of physiological pregnancy and placental insufficiency to analyze morphofunctional parallels between these indicators in the third trimester of pregnancy.

MATERIALS AND METHODS: Twenty-nine women on the 34–35 weeks of pregnancy (period of physiological maturity of the activity–rest cycle in the fetus) were screened. The main group consisted of 19 patients. The inclusion criteria were as follows: single-fetal pregnancy, fetometric indicators below the 10th percentile, and presence of blood flow disorders in the main vessels of the mother–placenta–fetus functional system. The comparison group included 10 relatively healthy women. The criteria for inclusion in the comparison group were as follows: single-fetal physiological pregnancy, fetometric indicators above the 10th percentile, and absence of Doppler disorders of placental blood flow. Fetometry and Doppler studies of the placental blood flow in the main arteries of the functional system of the mother, placenta, fetus were performed using the Voluson 730 Expert ultrasound device (GE, USA). The activity–rest cycle in the fetus was evaluated using Sonicaid Team Care fetal monitor (Oxford, UK). Placental tissue was taken from the central placental area for immunohistochemical analysis of VEGF and PlGF expression with primary monoclonal antibodies of the main women group and comparison group after childbirth (1:100, Abcam, UK).

RESULTS: A direct correlation between the expression of VEGF in the central zone of the placenta and index resistance (IR), ripple index (RI) in the uterine arteries, as well as the cerebroplacental relationship — CPR (r₁=0.487; p₁=0.035; r₂=0.487; p₂=0.035; r₃=0.578; p₃=0.030, respectively) in women of the main group was found. A direct correlation was established between the expression of VEGF in the central zone of the placenta and IR in the umbilical artery (r=0.49; p=0.033) in patients of the main group. The analysis of the rest–activity cycle in fetuses of women of the main group showed that at 34–35 weeks 73% of them do not form it: the behavior of fetuses is represented only by the activated state. An inverse relationship was found between VEGF expression and the motor-cardiac reflex amplitude (r=–0.866; p=0.05) as well as the heart rate oscillation amplitude (r=–0.866; p=0.05) in fetuses of women of the main group.

CONCLUSIONS: The identified morphofunctional parallels will allow to develop non-invasive pathogenetic prognostic models for prenatal diagnosis of fetal development delay with different degrees of growth restriction.

AIM: The study aimed to assess the effectiveness of alloferon in human papillomavirus (HPV)-associated cervical neoplasia (grade I) based on the analysis of the cytokine profile in cervical mucus as well as markers of apoptosis in cervical epithelial cells.

MATERIALS AND METHODS: The study enrolled 98 women, including 55 women of reproductive age with cervical intraepithelial neoplasia (CIN) associated with HPV infection and 43 conditionally healthy women without HPV infection. Factors of cytokine response and markers of apoptosis under normal and pathology conditions were assessed and compared.

RESULTS: The imbalance of pro-inflammatory and anti-inflammatory cytokines, in favor of the latter, is an important factor that supports the persistence of HPV-associated grade I CIN. Reducing caspase-3 and caspase-9, increasing interleukin-18, and subsequent activation of interferon gamma against the background of alloferon use are favorable signs of substantial elimination of the HPV.

CONCLUSIONS: The results of this study show considerable elimination of HPV in patients with grade I CIN when using immunological antivirus therapy.