Kuzmin N. Optimizing the tactics of managing pregnant women at risk for the development of preeclampsia: personalization of risks, the possibility of prediction and targeted prevention.

The work is devoted to the improvement of obstetric outcomes in pregnant women at risk of developing preeclampsia based on a comprehensive clinical and laboratory assessment of the associative relationship of some markers of endothelial dysfunction and the state of blood flow in the uterine vessels with the level of calcidiol, improvement of approaches to the prediction and prevention of preeclampsia. The risk of developing preeclampsia was personalized by determining the Bsml (rs1544410) polymorphism of the gene encoding vitamin D receptors and genes encoding some markers of endothelial dysfunction (TNFα, IL-1β, IL-6). It was shown that in conditions of VD deficiency in women with Bsml polymorphic genotype A/G (VD receptors) the risk of developing preeclampsia is significantly higher (4 times). It was found that the average level of vitamin D in the blood of pregnant women with preeclampsia is significantly lower, and the specific gravity of VD in a deficient state is 10 times higher in them than in women with a normal course of pregnancy (63% vs. 5.7%). It was shown that in pregnant women with preeclampsia, the level of some markers of endothelial dysfunction in the blood is significantly higher than in healthy women, and there is a reliable statistically significant correlation between the levels of IL6, IL1β and the level of calcitriol in the blood of pregnant women: the lower the level of calcitriol, the higher the content of markers of endothelial dysfunction. The paper shows that there is a reliable direct correlation between the impaired VD status and indicators of uteroplacental perfusion, namely in the pool of uterine arteries, in the 1st trimester, and in conditions of vitamin D deficiency, the resistance of the vascular wall in the uterine arteries increases. In order to reduce the frequency of preeclampsia and prevent perinatal complications, in addition to the generally accepted recommendations, an algorithm for the examination and management of women from the high-risk group by determining and correcting vitamin D status has been developed.