As we have demonstrated in the previous chapters, the outcome of pregnancy is essentially determined by the folliculo-luteal function (FLF) – the level of follicular oestradiol and then luteal progesterone – which defines the conditions for placentation. Insufficient FLF and the consequent inadequate placentation, which is known as ischaemic placental disease, underlie preterm birth, intrauterine growth retardation (IUGR) and preeclampsia. Because of the extraordinary importance of this issue, we investigated how the normalisation of FLF prior to conception can influence the prevalence of these three obstetric complications.
During the treatment of unexplained infertility, successful birth occurred in 606 cases with physiological FLF (average luteal progesterone >23 ng/ml). The rates of preterm birth, IUGR, newborn weight <2500 g and preeclampsia decreased by an order of magnitude in singular births (0.7 %, 0.7 %, 1.0 % and 0 %, respectively) compared to both the Hungarian population (9.5 %, 10.1 %, 9.3 % and 3.0 %, respectively) and the untreated control group (30.2 %, 30.2 %, 35.7 % and 5.6 %, respectively). Besides the less frequent occurrence of preterm and growth-retarded newborns, their characteristics were also significantly (p < 0.001) better compared to the national average: except for one case, every preterm birth were late preterm deliveries after the 34th week, with newborn weights >2200 g, and every newborn with IUGR was born after the 37th week with a weight of >2000 g.
Multiple pregnancies conceived four times more often with physiological FLF (6.3 %) than the national average (1.6 %), while the occurrence of preterm births was significantly (p < 0.001) lower with physiological FLF than the national average, 23.7 and 47.1 %, similar to that of IUGR, 18.4 and 47.7 %.
Through the normalisation of FLF before conception, the incidence of these three obstetrical complications can be reduced from 21.8 to 1.4 % with singular births and from 22.6 to 2.9 % including all births. In addition, newborn characteristics are also significantly improved compared to spontaneously conceived pregnancies.
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