Etiology of placental insufficiency in women in the second trimester of gestation during the epidemic of influenza A(H3N2) and pandemic influenza(H1N1)pdm

Aim. To study the etiology of placental insufficiency in women in the second trimester of gestation during the influenza A(H3N2) epidemic and the A(H1N1)pdm pandemic.

Materials and methods. In 1865 patients in the second trimester of pregnancy, uncomplicated and complicated by exacerbation of chronic ENT pathology leading to the development of placental insufficiency, using laboratory methods in the blood, nasal epithelium and biological fluids, pathogens of monoand mixed infections (influenza A(H1N1)pdm), A(H3N2), influenza B, parainfluenza type 1-3, adenovirus, respiratory syncytial virus (RS), cytomegalovirus (CMV), herpes simplex virus type 1 and type 2 (HSV-1,2 type), candida infection (Candida albicans), chlamydia (Chlamydia trachomatis), mycoplasmosis (Mycoplasma hominis) and ureaplasmosis (Ureaplasma urealyticum) were detected. The first group consisted of 873 women with placental insufficiency diagnosed during the influenza A(H3N2) epidemic, the second group consisted of 890 patients with placental insufficiency diagnosed during circulation of the influenza A(H1N1)pdm in the population. The control group were 42 women without ENT diseases and placental insufficiency caused by monoand mixed viral infections during influenza A(H3N2) and 60 women with similar somatic, infectious and obstetric status, examined during pandemic influenza A(H1N1)pdm.

Results. With the development of placental insufficiency in women of the second group, compared with the first one, mono-influenza B and parainfluenza types 1-3 are diagnosed less frequently, as well as a combination of influenza A(H1N1) pdm and influenza B; influenza A(H1N1)pdm and parainfluenza types 1-3; influenza A(H1N1)pdm and RS virus; CMV and Chlamydia trachomatis; Mycoplasma hominis and Ureaplasma urealyticum; HSV-1,2 type, Candida albicans and Chlamydia trachomatis; as well as HSV-1,2 type, Candida albicans and Ureaplasma urealyticum. At the same time, exacerbations of mono-CMV, mono-HSV-1,2 type and Candida albicans are more common, as well as combinations of CMV+HSV-1,2 type; CMV+Candida albicans; CMV+Ureaplasma urealyticum; and CMV+Mycoplasma hominis; CMV+HSV-1,2 type+Candida albicans.

Conclusion. In the etiology of placental insufficiency in acute diseases of the ENT organs in women in the second trimester of gestation against the background of circulation of the A(H1N1)pdm influenza in the population, compared with placental dysfunction in pregnant women with a similar ENT pathology during the influenza A(H3N2) epidemic, there is an increase in the proportion of monocytomegalovirus, herpesvirus and candida infections, as well as mixed cytomegalovirus infection, the reactivation of which may be due to more pronounced virusinduced immunosuppression and hormonal status disorders, leading to local dysbiosis.

1. Balmasova I.P., Malova E.S., Sepiashvili R.I. [Viral and bacterial coinfection as a global problem of modern medicine]. RUDN Journal of Medicine 2018; 22(1):29–42 (in Russian). https://doi.org/10.22363/2313-0245-2018-22-1-29-42

2. Gorikov I.N., Reznik V.I., Nakhamchen L.G., Sergievich А.А. [Etiological role of respiratory and persistent infections in the development of placental insufficiency in women in the second trimester of pregnancy. In: Proceedings of the 10th Congress of Pulmonologists of Siberia and the Far East]. Blagoveshchensk; 2023:183−187 (in Russian). ISBN: 978-5- 905864-27-8.

3. Tarbaeva D.A., Belokrynitskaya T.E., Strambovskaya N.N., Dagbaeva S.D. [Molecular-genetic determinants of severe complicated influenza A(H1N1) in pregnant women]. Far Eastern Medical Journal 2014; 4:53−58 (in Russian). https://elibrary.ru/tflxwj

4. Tsvetkov V.V., Deeva E.G., Danilenko D.M., Sologub T.V., Tikhonova E.P. [Molecular genetic factors of pathogenicity of influenza A virus (H1N1)pdm09]. Epidemiology and Infectious Diseases 2014; 19(4):4−11 (in Russian). https://elibrary.ru/szyerv

5. Dobrokhotova Yu.E., Bondarenko K.R., Shadrova P.A. [Current view on infectious factor of early reproductive losses and possible pathogenetic mechanisms]. Russian Journal of Human Reproduction 2020; 26(3):23 30 (in Russian). https://doi.org/10.17116/repro20202603123

6. Pestrikova T.Yu., Yurasova E.A., Kotelnikova A.V. [Vulvovaginal candidiasis: modern look at the problem]. Russian Journal of Woman and Child Health 2017; 25(26):1965−1970 (in Russian). https://elibrary.ru/yoqnuo

7. Olinichenko S.A. [Experience treating urogenital candidiasis]. Akusherstvo i Ginekologiya (Obstetrics and Gynecology) 2011; (7-1):68−69 (in Russian). https://elibrary.ru/pftvft

8. Sakaniya L.R., Mildzikhova D.R., Korsunskay I.M. [Candida infection during immunosuppressive therapy]. Dermatologiya. Prilozheniye k zhurnalu Consilium Medicum 2019; (1):56–58 (in Russian). https://elibrary.ru/zfbenn

9. Tikhomirov A.L., Yudayev V.N., Lubnin D.M. [Modern algorithm for the treatment of inflammatory diseases of the reproductive system]. Russian Medical Journal 2003; (1):12–20 (in Russian).

10. Ignatko I.V., Rybin M.V., Dubolazov V.D. [Precaution of placental insufficiency in high-risk group of pregnant women]. Gynecology, Obstetrics and Perinatology 2006; 5(1):11‒20 (in Russian). https://www.elibrary.ru/glmroh

11. Gorikova I.A., Gorikov I.N., Barabanova V.G., Taraburova N.G., Sorokina T.S., Rabinovich B.A. [Status of ENT organs in women with acute exacerbation of chronic cytomegalovirus infection in the II trimester of pregnancy]. Allergologiya i immunologiya 2011; 12(1):88 (in Russian).

12. Sadova N.V., Zaplatnikov A.L., Shipulina O.Yu., Domonova E.A., Karaseva L.N., Podkopayev V.N. [Intrauterine infections: a current state of the problem]. Clinical Practice in Pediatrics 2013; 8(5):С.63‒66 (in Russian). https://www.elibrary.ru/ruhbjf