EFFECT OF HELICOBACTER PYLORY ON THE COURSE OF EARLY EMESIS GRAVIDARUM IN PREGNANT WOMEN WITH CHRONIC GASTRITIS

Abstract

Introduction. The questions of the role of the infectious factor in the course of pregnancy, delivery and the newborn state are important due to the need of the determination of the appropriate management to prevent adverse maternal and fetal outcomes. Currently, the issues of extragastric manifestations associated with Helicobacter pylori (Hp) are being investigated, suggesting possible involvement of Hp in pregnancy complications. Study objective is to evaluate the course of early gestosis (emesis gravidarum), depending on the presence of Helicobacter infection in women with chronic gastritis. Material and methods. We examined 120 pregnant women in the gestation period of 8-12 weeks who had early gestational complications: emesis gravidarum, threatened miscarriage, spontaneous miscarriage and stillbirth, which were divided into 2 groups according to the presence of chronic gastritis: group 1 of 58 pregnant women with gastritis and Group 2 of 62 pregnant women without gastritis. Pregnant women with this form of pregnancy complication were additionally examined to perform the study objective of determining the features and frequency of early gestosis (emesis gravidarum). In addition to clinical and laboratory studies performed in accordance with the protocols of the Ministry of Health of Ukraine for the monitoring of pregnant women, the examined patients were diagnosed with a non-invasive Helicobacter pylory method by rapid chromatographic immunoassay for the detection of serum IgG antibodies to Hp. To determine the type of gastritis, the determination of the level of basal secretion of gastrin 17 (G-17) in the serum was performed with the stimulating test with which the presence and severity of atrophy of the mucous membrane of the antral gastric department can be determined. Pregnant women of both groups who had early gestosis (emesis gravidarum) were evaluated for the severity of pregnancy vomiting using a questionnaire method that included an evaluation of clinical and laboratory parameters. The obtained results were processed by methods of mathematical and statistical analysis with the determination of mean values (M ± m), Student’s test and reliability indicator (difference р<0.05 was considered statistically significant). Results. Among the early gestational complications in pregnant women of groups 1 and 2, early gestosis (emesis gravidarum) had the same frequency and was 29.3% among pregnant women with chronic gastritis and 29.0% among women without gastritis. The positive result of detection of IgG antibodies to Helicobacter pylory in group 1 was 88,2%, in group 2 – 27,8%. When comparing the frequency of detection of antibodies in pregnant groups examined at different severity of emesis gravidarum, it was found that positive results were more common in group 1 with moderate (66,7%) and severe (26,7%) course. In group 2, a positive result was observed in mild emesis gravidarum (60,0%). When investigating the frequency of Hp detection in women with different types of gastritis and emesis gravidarum, it was found that Hp antibodies were more common in women of group 1 with hyperacid type of gastritis (53.3%), and in group 2 with hypoacid type of gastritis (80.0). The evaluation of the clinical course and laboratory data showed the difference, which was more often associated with the type of gastritis, which was responsible for the clinical course of pregnancy in women with chronic gastritis and early gestosis and the degree of emesis gravidarum. Conclusion. The presence of Helicobacter pylory infection is more common in pregnant women with chronic gastritis and vomiting of pregnant women. The clinical course of early gestosis in these conditions depends on the level of gastric acidity, which determines the severity of emesis gravidarum.