NEW INSIGHT INTO WOMEN WITH FIBROMUSCULAR DYSPLASIA – OBSTETRIC AND GYNECOLOGIC HISTORY, STEROID PROFILE AND THE REPRODUCTIVE ARTERIAL BLOOD FLOW EVALUATION – ARCADIA-GYN STUDY

Objective: The aim of the study was to assess obstetric and gynecology history, hormonal profile and the blood flow in arterial reproductive system in women with fibromuscular dysplasia (FMD) enrolled in ARCADIA-GYN study. Design and method: We enrolled 42 women with FMD (age: 18-46 years old) and matched 45 healthy controls. From patients a detailed obstetric and gynecological history was collected. The levels of basic sex hormones and the steroid profile was determined. During transvaginal ultrasound end-diastolic velocity (EDV) and peak systolic velocity (PSV) were measured in the uterine and ovarian arteries, and the S/D ratio and resistance index (RI) were calculated. By CT-angiography the uterine arteries and their ovarian branches were assessed for dysplasia involvement in 32 women with FMD. Results: We found no significant differences in menstruation, hormonal contraception and fertility between those two groups. In women with FMD we observed significantly more often pregnancy-related complications than in women without FMD (65.4% vs. 28%, p=0.007), especially hypertension (50% vs. 0%, p<0.001) and Apgar score <10 points in the newborn (46.2% vs. 16%, p=0.02). There were no significant differences in the plasma level of basic sex hormones between women with FMD compared to healthy controls. However, we noticed significantly lower concentrations of progesterone, DHEA, DHEA-S, testosterone, and 11-deoxycortisol in women with FMD. In addition, women with FMD were characterised by an increased EDV (6.45 vs. 5.41 cm/s, p=0.047) and a decreased RI (0.82 vs. 0.86, p=0.014) and S/D (5.36 vs. 6.93, p=0.006) in the right uterine artery compared to healthy women. The CT-angiography revealed dysplasia changes in the uterine arteries in almost 1/3 of women with FMD (31.25%). Conclusions: Women with FMD have different hormonal profile and more frequency develop pregnancy-related complications compared to women without FMD. Moreover, for the first time we report that fibromuscular lesions can also be present in the uterine arteries. However, it it still unknown whether the complications observed during pregnancy are related to hormonal profile and the presence of vascular changes in uterine arteries.