Hormonal basis of the pathological course of the first trimester of pregnancy in women with adenomyosis, Гормональні основи патологічного перебігу першого триместру вагітності у жінок з аденоміозом

<jats:p>Background. Adenomyosis is internal endometriosis of the uterus, in which endometrial glands and stroma deeply and chaotically infiltrate the myometrium. Adenomyosis is a common disease with poorly understood pathogenesis and pathophysio­logy, its incidence ranges from 10 to 57 %. Risk factors include childbirth, a history of dilation, curettage, and other uterine surgeries that can disrupt the endometrial-myometrial interface and promote invasion, implantation, embedding, and formation of endometrial colonies in the myometrial wall, increasing the deve­lopment of adenomyosis. The course of pregnancy in women with adenomyosis is unclear. The purpose was to investigate changes in hormonal balance during pregnancy in patients with adenomyosis and their impact on the spectrum of complications in the first trimester of pregnancy. Materials and methods. One hundred and seventeen pregnant women were under observation. The first group included 27 patients with adenomyosis, whose pregnancy was followed up in accordance with current regulatory documents, the second group consisted of 40 women who received the adenomyosis treatment we proposed and underwent pre-pregnancy training, and the control group included 50 healthy pregnant women. Participants underwent hormonal examinations: determination of estradiol, estriol, progesterone, sex hormone-binding globulin, prolactin, cortisol, and catecholamines. Statistical processing of the obtained data was carried out using the standard Statistica for Windows 13.0 software package. Results. In group I, the content of estradiol, progesterone, sex hormone-binding globulin (p &lt; 0.05) and estriol (p &lt; 0.01) was significantly reduced compared to healthy pregnant women. In group II, the level of these hormones did not differ from that of the control group (p &gt; 0.05). Women with adenomyosis showed an increased content of stress hormones compared to the control group: in group I, it was prolactin (p &lt; 0.01) and cortisol (p &lt; 0.05), in group II, it was cortisol (p &lt; 0.05). In group I, the level of adrenaline and noradrenaline is higher than that of the control group (p &lt; 0.01) and group II (p &lt; 0.05). The dopamine content is halved compared to the controls (p &lt; 0.01) and 1.9 times lower than in group II (p &lt; 0.05). Therefore, pregnancy with adenomyosis occurs under conditions of biochemically confirmed stress homeostasis, which, together with hormonal disorders, manifests clinically in the form of complications during the first trimester of pregnancy. Pregnancy in women with adenomyosis who did not have pre-pregnancy training is accompanied by miscarriage in almost 90 % of cases, unlike women in group II (p &lt; 0.01), and 4 times more often than in patients with placentation pathology. Conclusions. Patients with adenomyosis should be considered at high obstetric risk. In women with adenomyosis, a decrease in estrogen and progesterone (p &lt; 0.05), an increase in stress hormones such as prolactin (p &lt; 0.01) and cortisol (p &lt; 0.05) was detected in the first trimester of pregnancy. A correlation was found between the content of stress hormones in the blood serum of pregnant women with adenomyosis and miscarriage: adrenaline (r = +71, p &lt; 0.01), dopamine (r = –0.63, p &lt; 0.05), cortisol (r = +0.57, p &lt; 0.05). Pre-pregnancy training in women with adenomyosis significantly reduces the incidence of miscarriage and placentation pathology.</jats:p>