State Institution «Institute of Pediatrics, Obstetrics, and Gynecology named after Academician O. Lukyanova of the NАМS of Ukraine», 8 Platona Mayborody Str., Kyiv, 04050, Ukraine.
Probl Radiac Med Radiobiol. 2023 Dec;28:468-485. doi: 10.33145/2304-8336-2023-28-468-485.
The materials of the article are based on the results of our past studies of morphological and immunohistochemical features of placental damage due to 137Cs incorporation.
to determine the effectiveness of radioprotective therapy in preventing reproductive losses and perinatal consequences associated with the incorporation of radionuclides in the placenta.
According to the research design, the first group consisted of 153 women with reproductive losses in anamnesis and signs of termination of the current pregnancy. The control consisted of 30 women with a physiological pregnancy and an uncomplicated history. Based on the fact that one of the causes of premature termination of pregnancy is the vulnerable effect of 137Cs incorporated in the placenta, «Apple Pectin Antioxidant» (the «APA») with a high sorption potential was included in preventive measures regarding reproductive losses and perinatal consequences. The effectiveness of therapy with the inclusion of «Apple Pectin Antioxidant» was evaluated based on indicators of the fetoplacental complex and pregnancy scenarios. The results were compared with the effectiveness of standard treatment for habitual miscarriage of pregnancy.
It was established that the destructive effect of incorporated 137Cs leads to placental dysfunction and fetal distress. Therapy with the inclusion of «APA» more significantly than standard treatment increases the progesterone-synthesizing function of the placenta, microcirculation, adaptation potential, and antioxidant protection of cells with the efficiency of 7.5 %, 10.7 %, 17.7 %, and 43.4 %, respectively. «APA» has a positive effect on the scenarios of pregnancy. «APA» in the composition of therapy to preserve pregnancy contributed to a decrease in the frequency of premature births by 11.4 % and an extension of their term to 34 weeks of gestation. Extending the gestational age of preterm birth reduced the frequency of severe asphyxia by 18.7 %, hypoxic-ischemic central nervous system injury by 13.5 %, respiratory distress by 17.3 %, and intraventricular hemorrhage 2nd and 3rd degrees by 12.7 %.All children were born alive due to the preservation of the compensatory ability of the placenta.
Termination of pregnancy is a universal reaction of the mother and the fetus to negative exogenous and endogenous influences. Placental dysfunction is the most frequent cause of reproductive losses. Incorporated 137Cs is one of the factors that disturb the architecture of the placenta. Extreme effects depend on the number of incorporated 137Cs and the compensatory capacity of the placenta. Today, the possibility of internal exposure to 137Cs is associated due to consumption of agricultural products. Unfortunately, the level of food contamination with radionuclides remains higher than permissible. Living in an area with a standard radiation background does not guarantee a person the radiation safety of agricultural products. The confirmation is the accumulation of 137Cs in the placentas of women from different regions of Ukraine. The high efficiency of therapy with «APA» is associated with the removal of radionuclides and the minimization of the effect of internal irradiation, which made it possible to reduce the frequency of termination of pregnancy by 28.0 % due to the reduction of cases of premature births (-11.4 %), spontaneous abortions (-11.0 %), termination of pregnancy (-5.5 %). The «APA» is advisable to prescribe from pregravid and during pregnancy to all women, regardless of the region of residence.
确定放射性防护治疗在预防与胎盘内放射性核素摄入相关的生殖损失和围产期后果方面的有效性。
根据研究设计，第一组包括 153 名有生殖损失病史和当前妊娠终止迹象的女性。对照组由 30 名有生理妊娠和无复杂病史的女性组成。由于胎盘内 137Cs 摄入会导致脆弱效应，是导致妊娠提前终止的原因之一，因此在预防生殖损失和围产期后果方面纳入了具有高吸附潜力的“苹果果胶抗氧化剂”（“APA”）。根据胎-胎盘复合体和妊娠情况的指标来评估包含“苹果果胶抗氧化剂”的治疗效果。将结果与习惯性流产的标准治疗效果进行比较。
研究发现，摄入的 137Cs 的破坏性影响导致胎盘功能障碍和胎儿窘迫。与标准治疗相比，包含“APA”的治疗更显著地增加了胎盘合成孕激素的功能、微循环、适应潜力和细胞抗氧化保护，效率分别为 7.5%、10.7%、17.7%和 43.4%。“APA”对妊娠情况有积极影响。“APA”在保胎治疗中的应用有助于早产频率降低 11.4%，并将其妊娠期延长至 34 周。延长早产的胎龄可使严重窒息的频率降低 18.7%、缺氧缺血性中枢神经系统损伤降低 13.5%、呼吸窘迫降低 17.3%、2 度和 3 度室管膜下出血降低 12.7%。由于胎盘代偿能力得以维持，所有儿童均存活。
妊娠终止是母亲和胎儿对负向外源和内源影响的普遍反应。胎盘功能障碍是生殖损失最常见的原因。摄入的 137Cs 是扰乱胎盘结构的因素之一。极端影响取决于摄入的 137Cs 数量和胎盘的代偿能力。如今，由于食用农产品，人们可能会受到内部 137Cs 的照射。不幸的是，放射性核素在食物中的污染水平仍然高于允许水平。生活在标准辐射背景下的地区并不能保证农产品对人体的辐射安全性。确认是乌克兰不同地区妇女胎盘内 137Cs 的积累。APA 治疗的高效性与放射性核素的去除和内部照射效应的最小化有关，这使得通过减少早产（-11.4%）、自然流产（-11.0%）和妊娠终止（-5.5%）的发生来降低妊娠终止的频率成为可能。无论居住地区如何，建议所有女性在怀孕前和怀孕期间都服用 APA。
