War, stress, pregnancy: how to reconcile problematic issues?

The article provides data on current stress loads in the population of Ukraine, which have significantly increased as a result of emotional overstrain (stress) and the reduction of periods of positive emotional states. The presence of active military operations in the country and, as a result, the appearance of the population with the status of "displaced persons”;the part of the population that is/was in the zone of temporary occupation;the appearance of the wounded and disabled persons among the civilian population led the completely new tasks for the organism adaptive systems, which it is not always ready to overcome them. Over the last two year, the life of a person in Ukraine has been affected by a combination of two "dark forces”, namely, the war and the COVID-19 pandemic, and this influence is still continuing. The war for almost a year led to the layering of acute stress on already existing problems, deterioration of the social situation;forced change of place/country of residence (often repeated changes);interruptions in the supply of quality food products, medicines, dietary supplements, etc.;violation of "doctor-patient” contacts and, as a result, the impossibility of receiving timely and high-quality consultations and treatment. On the background of these problems there are significant risks of wartime for pregnant women, which can hinder the favorable course and termination of pregnancy. Among the most significant difficulties is a severe psychological trauma. The problem of the impact of the war on the pregnant women and the results of childbirth in our country began to be considered since 2014, when as a result of Russia's aggression in the east of the country and in the Crimea a completely new part of the population appeared – internally displaced persons (IDPs) from these regions. To date, the significantly increased contingent of IDPs has also been joined by those persons who displaced to other countries because of the war from February 24, 2022. The stay of a pregnant woman in conditions of acute or long-term chronic stress negatively affects the course of pregnancy, increasing the number of complications and negatively affecting the condition of the fetus and newborn. Pregnancy can also be considered a significant adaptive load, which requires the woman's body to mobilize mechanisms for syn-chronization between indicators of the basic systems and a favorable course of the gestation and childbirth process. Even during its physiological course it has a certain influence on the psychological condition of a woman, and some authors consider it even as a crisis situation, or as a "period of psychological uncertainty”. Individual features of response to stress cannot be dismissed either. Yes, the degree of reaction of a pregnant woman can be completely different depending on the specifics of the situation. One of the effective and available ways to prevent the effects of long-term stress during pregnancy is magnesium (Mg) supple-mentation in its oral form, taking into account bioavailability and the daily dose for pregnant women. Magnesium is indis-pensable in maintaining the conduction of nerve impulses, serves as a natural muscle relaxant that relaxes smooth and skeletal muscles, has a positive effect on the functioning of the placenta and endothelium, ensures the full development of the fetus in synergy with other useful substances, in particular B vitamins. The preparations based on magnesium salts with organic acids (orotic acid, vitamin B6), in which the anion of the acid serves as a "magnesium carrier” (ligand) into the cell, are characterized by a high bioavailability. It is important in the context of the impact on the central nervous system during the war that magnesium, vitamin B6 and orotic acid potentiate each other's anti-stress effect. Our experience allows us to recommend a magnesium preparation for long-term use, starting with pre-gravid preparation, throughout pregnancy and lactation, which includes the chelated form of marine magnesium «Simag 55» (p ri fied natural marine mineral extract) with two conductors (vitamin B6 and orotic acid) to ensure the highest bioavailability. © The Author(s) 2023.

PREGNANCY AND PERINATAL OUTCOMES OF COVID-19 (SARS-COV-2).

This article presents current data on the impact of COVID-19 (SARS-CoV-2) on pregnancy and perinatal consequences. The working theories of the pathogenesis of obstetric and fetal complications due to infection during pregnancy, already proven to date, are considered. Symptoms of COVID-19 disease, the risk of their development, and frequency of severe disease in non-pregnant and pregnant women of reproductive age do not differ significantly. However, there are powerful studies that have shown that this infection in pregnant women leads to a high probability of a dramatically severe and fulminant course. Pregnant women with SARS-CoV-2 infection have an increased risk of preeclampsia, incl. severe, hemolysis, thrombocytopenia and increased levels of liver enzymes compared with pregnant women without infection. Women who have COVID-19 are twice as likely to have preterm rupture of the membranes and three times as likely to have a preterm birth compared to the not infected pregnant women. Vertical transmission of the virus from mother to fetus is likely, but data are insufficient to be certain. There is also insufficient evidence of an increased miscarriage rate and teratogenic effects of the COVID-19 virus. However, antenatal fetal death is statistically significantly more common in infected pregnant women than in uninfected pregnant women. Morphological and functional disorders in the chorion/placenta are the main pathogenetic factor in the development of preeclampsia, intrauterine growth retardation, antenatal fetal death and impaired state of the fetus and children born by women with COVID-19. Many studies report that mothers with confirmed COVID-19 infection has asymptomatic babies. At the same time, some studies indicate adverse complications in newborns from infected mothers. The most common neonatal disorders in babies from pregnant women with COVID-19 are tachypnea, hyperthermia, and gastrointestinal disorders, in particular vomiting and flatulence. Further research of the COVID-19 impact on pregnancy and perinatal outcomes is urgently needed.Copyright © 2022 Trylyst. All rights reserved.