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UDC 611.018.52:613.99:618.2
CONNECTION OF BIOLOGICAL AND SEASONAL FACTORS WITH INDICATORS OF THE AMOUNT AND ACTIVITY OF PLATELETS BY PHYSIOLOGICAL PREGNANCY IN THE CONDITIONS OF ALTAI KRAI
Altai State Medical University, Barnaul A.E. Maltseva
The aim of this work was to study the dynamics of platelet number in pregnant women due to biological (weight, body length, age) and seasonal factors. The data of examination records of pregnant women served as a material for the study. Data on the number of platelets on the 12th and 28th weeks of pregnancy, growth, weight of patients before pregnancy are taken into account. The possible causes of platelet dynamics, taking into account the analysis of the results of other authors, are considered. The results indicate the influence of solar activity on the hemostatic system and the composition of peripheral blood. It is shown that, by normal platelet content, their dynamics during pregnancy depends on biological factors and is subject to intra-annual fluctuations, thus, seasonal shifts are observed.
Key words: platelets, pregnancy, mother's body composition, year season.
During pregnancy, develop adaptive shifts in hemostasis, reflecting the state in the system that limits blood loss during labor. The hemosta-siological status is characterized by an increase in the blood coagulation potential, an increase in the structural properties of the blood clot and inhibition of the enzymatic fibrinolytic activity [1]. These changes, together with an increase in circulating blood volume (CBV), prevent bleeding during the separation of the placenta, the formation of an intravascular thrombus and play an important role in preventing pregnancy complications such as thromboembolism and bleeding after the development of DIC syndrome. In normal pregnancy, there is an increase in the level of VII (proconvertin), VIII (anti-hemophilic globulin), X (Stuart factor) coagulation factors (from 50 to 100%), prothrombin level and IX factor (Christmas factor by 20-40% and especially plasma fibrinogen level.) The concentration of fibrinogen increases by 50%, which is the main cause of a significant increase in the erythrocyte sedimentation rate (ESR) during pregnancy. The prothrombin index also increases significantly by the 38th-40th week of pregnancy. The number of platelets decreases slightly due to their increased consumption. [2].
In the hemostasis system, platelets play a special role, containing thromboplastic and antiheparin factors, fibrinase, fibrinolytic agents, proteins that provide adhesion, aggregation and platelet release reactions. Information on the change in the number of platelets during the gestational process during physiological pregnancy is ambiguous.
In women, the normal level of platelets in the blood is 150-450 thousand/1 ^l. With the onset of pregnancy, the level of platelets in the blood decreases slightly, which is called thrombocyto-penia. In pregnant women, 100-415 thousand/1 ^l of platelets is normal. This is due to the addition
of the third circulation (placental) and some blood thinning. Thus, most authors point to a decrease in the number of platelets throughout pregnancy and associate this with both an increase in circulating blood volume and the consumption of platelets in the uteroplacental circulation. Other researchers do not detect changes in platelet count during pregnancy and even report cases of thrombocyto-sis [3] as a result of dehydration and blood clots or the presence of a hidden disease. The constitution of a pregnant woman is not taken into account.
It is known that the dynamics of hemostasis is subject to seasonal changes [4]. Knowledge of seasonal changes in platelets has a prognostic value, especially in cases where background indicators indicate thrombocytosis or thrombopenia.
The aim of the research was to study the dynamics of platelet count in pregnant women due to biological and seasonal factors.
Materials and methods
The material for the study was the data of examination records of 1154 pregnant women under observation at maternity hospital No. 2 in Barnaul during 1998. The age of those surveyed is 15-43 years old (average age is 24.6 ± 0.19 years). In order to verify the type and degree of identified dependencies, a repeated analysis was carried out on the available material of 2014 data (2150 women). The selection of materials for the analysis in these years was justified by the fact, that in 1998 and 2014, the indicators of environmental factors were the closest and typical for the climate of Altai Krai; The average annual indices of solar activity were comparable and corresponded to the middle of the ascending branch of the 11-year solar cycle. Seasons were classified as follows:
1. Astronomical seasons: counted from the points of the solstice (in winter - of December
22, in spring - of March 21, in summer - of June 22, in autumn - of September 22). Determined by the dynamics of the rotation of the Earth around the sun.
2. Calendar seasons: dividing the year into four seasons, three calendar months each: autumn -from mid-August to mid-November; winter - from mid-November to mid-February; spring - from mid-February to mid-May; Summer - from mid-May to mid-August.
3. Climatic seasons: dividing the year into four seasons according to the annual temperature of the environment of the region [1].
Among the patients were women whose pregnancy proceeded in rural and urban environments. The study took into account data on the number of platelets at the 12th (T12) and 28th (T28) weeks, pregnancy duration, height (average height 164.14 ± 0.24 cm), weight of patients before pregnancy (average weight 62, 14 ± 0.43 kg). The determination of body mass index (BMI) was carried out according to the formula: BMI = body weight (in kg)/ body length (in cm2). The following grades of body mass index (BMI) taken for women were taken into account: body mass deficiency - BMI <19; normal body weight - 19 <BMI <24; overweight (pre-obesi-ty) - BMI> 29. We used the methods of parametric statistics with the calculation of the mean and its errors and regression analysis using the "Statistical" package.
Results and discussion
The total sample included three people with a level of TP12 < 150 thousand/1 mm3 and one person with a level of TP28 < 150 thousand/1 mm3, and no persons with platelet count >400 thousand/1 mm3 were found. Upon further analysis, cases of thrombocytopenia were excluded from the sample as atypical. Thus, in the pregnant wom-
en examined, the platelet count at the 12th and 28th weeks of gestation was within the physiological norm [5].
Often occurring extragenital pathology is a metabolic syndrome (excess of proper body weight). Among the disorders accompanying metabolic syndrome are the tendency to thrombosis and an increase in plasma levels of plasminogen activator inhibitor [4]. Metabolic syndrome is a combination of abdominal obesity, hyperglycemia, dys-lipoproteinemia, arterial hypertension, impaired hemostasis and chronic subclinical inflammation, the pathogenetic essence of which is the phenomenon of insulin resistance (IR) [6]. Interest in this problem is also explained by the significant contribution of the metabolic syndrome to the development and progression of cardiovascular diseases
[7].
In recent years, interest in studying the relationship of metabolic disorders, obesity and their attendant changes in the hemostasis system with an increase in cardiovascular complications in people with metabolic syndrome has grown significantly. To date, enough data has been accumulated indicating that insulin resistance (IR) and developing hyperinsulinemia (GI) may increase the risk of cardiovascular complications due to their coagulation disorders. Although, if the majority of researchers are of the same opinion about the nature of changes in the vascular and plasma components of the he-mostasis system in the metabolic syndrome, then judgments about the state of the platelet level of the coagulation system are very contradictory. In this regard, we determined the platelet count and assessed the degree of physiological throm-bocytopenia by the 28th week in pregnant women with different body mass index (BMI) values (Figure 1).
Figure 1 - The number of platelets during gestation in patients with normal weight (1) and obesity (2) All observed were divided into two groups: 1 - with a BMI <30 (84 people) and a BMI> 30 kg/m2 (834 people).
According to WHO criteria, obese women significantly dominate in the sample. Both at the 12th and 28 th weeks of pregnancy, platelet count is higher in the group of overweight women. The decrease in the number of platelets by the 28th week of gestation is more pronounced in women with obesity (4.9% vs. 2.2%). According to the authors, a correlation was found between the plasma lipid spectrum and the fatty acid composition of platelet membranes, due to changes in the content and ratio of omega-3 and omega-6 PUFAs against the background of atherogenic changes in the blood lipid profile in people with metabolic syndrome [5].
In their body, there is observed predominance of activated freely circulating morphological forms of platelets presented by disk echinocytes, sphero-
cytes, sphere echinocyte, and a relationship between the morphological forms of platelets and fatty acid composition of the membranes, due to an increase in omega-6 PUFA, there has been revealed a relationship between the number of active morphological forms of platelets and the level of functional platelet activity determined by the intensity of the aggregation response to the action of different inducers.
In the literature, there is no data on the effect of age and body length on platelet count in both women outside of pregnancy and during it. Regression analysis showed that at the 28th week of pregnancy, the number of platelets is inversely proportional to the length of the body (P = 0.02) and the age of the woman (P = 0.001) (Figure 2).
Figure 2 - Dependence of the number of platelets on the length of the body (1) and the age (2) of pregnant women
at the 28th week of gestation.
The relationship between the degree of reduction in the number of platelets by the 28th week of pregnancy in relation to their number at the 12th week with age was not found. Moderate thrombo-cytopenia without a change in their functional activity may be associated with increased consumption of platelets in the peripheral blood circulation [7].
Wallaschofski H. et al. [8] explain the decrease in the number of platelets during physiological pregnancy by platelet aggregation, which occurs under the influence of progesterone and prolac-tin. These hormones can cause platelet aggregation without the addition of aggregation inducers. Similar platelet activity was noted by R. Lifenko. in I-II trimesters, when platelet aggregation practically corresponds to that of non-pregnant women in phase II of the menstrual cycle, but by the third trimester, this indicator may decrease [9].
The change in the seasons has a significant effect on the dynamics of blood parameters. Seasonal changes are subject to coagulation of blood. Activation of the blood coagulation system occurs more often in spring and much less in summer. It is shown, that platelet aggregation activity is subject to sea-
sonal fluctuations, and all recorded aggregation indicators are higher in the autumn-winter period. The disaggregation component of the aggregation potential turned out to be the most variable, it prevails in the spring-summer time [5].
In our study, in meteorological conditions of Altai Krai, the maximum number of platelets at the 28th week of pregnancy was observed at conception in February, and the minimum - at conception in January and December. In May and August in pregnant women, the number of platelets increased, and in July - decreased (Figure 3).
The greatest manifestation of the physiological reduction in the number of platelets is noted by conception in December. The maximum severity of the physiological reduction in the number of platelets by the 28th week of pregnancy is observed in July (Figure 1). These results may have prognostic significance, especially in cases of the risk of thrombocytopenia or thrombocytosis. According to other authors, studies have shown that during the period of seasonal geomagnetic changes (winter - summer), the number of platelets decreases, mainly due to the redistribution of cell subpopulations. These results indicate the effect
of solar activity on hemostasis and peripheral blood composition. In a number of works, it has been shown that the state of microcirculatory hemostasis and the anti-aggregation activity of blood vessels in healthy people are associated with the seasonal content of antioxidants in the body. It is suggested that in the fall, when there are natural conditions for increasing the level of antioxi-dants (the diet is associated with the predominance of vegetables and fruits in the diet), the coagulation and aggregation ability of platelets is weak-
ened. Apparently, solar disturbances, as well as other factors of the human environment, are not an exception, and a healthy body responds to their impact with an adequate adaptive response: the acceleration of the blood clotting process is compensated by the activation of the blood fibrinolytic system to maintain the balance of blood rheological properties and energy processes in cells [eleven]. It is possible that in this case the functional properties of platelets also change.
Figure 3 - The number of platelets at the 28th week of gestation depending on the month of conception (1) and in different months of the year (2), the physiological decrease in the number of platelets from the 12 th to the 28 th week of pregnancy depending on the month of conception (3) and different months of the year (4).
Conclusions
1. In overweight women, the number of platelets at the 12th and 28th weeks of gestation is increased compared with women who have normal body mass index.
2. At the 28th week of pregnancy, the number of platelets is inversely proportional to the length of the body and the age of the woman.
3. The maximum number of platelets at the 28th week of pregnancy is noted by conception in February, and the minimum - by conception in January and December. In August, the number of platelets in pregnant women increased, and in July - de-
creased. The greatest manifestation of the physiological reduction in the number of platelets by the 28th week of pregnancy is observed by conception in December, and during pregnancy in July.
References
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Contacts
Corresponding author: Maltseva Anastasiya
Yevgenyevna, Senior Lecturer of the Department
of Biology, Histology, Embryology and Cytology
of ASMU, Barnaul.
656031, Barnaul, ul. Papanintsev, 126.
Tel.: (3852) 566927.
E-mail: [email protected]
