Risk factors associated with the development of undifferentiated connective tissue dysplasia

Development of the undifferentiated connective tissue dysplasia (UCTD) is influenced by various adverse factors to the fetus during intrauterine growth. There is not a clear linkage to the contribution of the separate factors to the development of the UCTD.

Aims of the study are to determine the risk factors associated with the development of the UCTD of the adolescents and to appreciate the predictive value of the examined factors related to UCTD to form the dispensary groups of the children with UCTD.

Materials and methods. During the first stage of the study there was an examination of 110 adolescents at the age of 10–14 years old, the UCTD presence was established according to the scale proposed by T.I. Kadurina and V.N. Gorbunova (2009). During the second stage the data of the prenatal casework and maternity hospital records attached to the out-patient medical records were examined to detect the specialties of the antenatal life course. During the third stage 2 groups were formed: with the presence of UCTD (n = 81) and without UCTD (n = 29). The mother groups were formed accordingly with the adolescents groups.

Results. The pregnancy of the mothers of the adolescents with UCTD proceeded against the anemia, threatening miscarriage, chronic fetal hypoxia, chronic fetoplacental insufficiency, toxicosis, gestosis, and concomitant chronic conditions (thyroid, kidneys, digestive apparatus, aspiration pathology) more common than the pregnancy of the mothers of the adolescents without UCTD. The binary logistic regression method allowed the predictors of the UCTD’s formation to be determined, there were: toxicosis during the gestation course (OR = 10.9; CI 95% 2.94–40.49), anemia of pregnancy (OR = 8.6; CI 95%: 2.42–30.81), gestosis (OR = 6.53; CI 95%: 1.27–33.71), chronic fetal hypoxia (OR = 4.4; CI 95%: 1.09–17.83) and pre-existing chronic conditions of the mothers (OR = 3.6; CI 95%: 0.86–15.48). Different factor combination enhances the likelihood of the delivery of a child with UCTD more than 6.5-fold: chronic conditions of the mothers and chronic fetal hypoxia (OR = 6.8; CI 95%: 1.95–48.57); anemia of pregnancy and chronic fetal hypoxia (OR = 7.2; CI 95%: 1.01–50.99), and toxicosis (OR = 10.4; CI 95%: 1.48–72.82).

Conclusion. The risk factors associated to the development of UCTD in adolescents are: toxicosis during the gestation course, anemia of pregnancy, gestosis, chronic fetal hypoxia and pre-existing chronic conditions of the mothers. The use of the equation of the binary logistic regression allows the prediction of the possibility of the development of UCTD in adolescents at the level of 80.9% and to form the dispensary groups of children in order to prevent the development of dysplastic-dependent pathology

1. Чемоданов В.В., Сесорова И.С., Шниткова Е.В. и др. Анкетирование индивидов в выявлении дисплазии соединительной ткани. Современные проблемы науки и образования. 2015; 2: 90. [Chemodanov V.V., Sesorova I.S., Shnitkova E.V. i dr. Questioning of individuals in detection of a dysplasia of connecting fabric. Sovremennye problemy nauki i obrazovanija. 2015; 2: 90 (in Russ.)].

2. Дисплазия соединительной ткани: тактика ведения пациентов в условиях общей врачебной практики. Проект клинических рекомендаций. Ассоциация врачей общей практики (семейных врачей) Российской Федерации. М., 2013: 5. [Connective tissue dysplasia: patient management tactics in the under the conditions of the general medical practice. Сlinical recommendations / Association of the general practice doctors (family physicians) of the Russian Federation. Moscow, 2013: 5 (in Russ.)].

3. Иванова Е.А., Плотникова О.В., Глотов А.В. и др. Профилактика потерь здоровья у лиц подросткового возраста с фенотипическими проявлениями дисплазии соединительной ткани. Казанский медицинский журнал. 2012; 1: 93–97 [Ivanova E.A., Plotnikova O.V., Glotov A.V. i dr. Prevention of the health problems in the adolescents with phenotypic manifestations of the connective tissue dysplasia. Kazanskiy meditsinskiy zhurnal. 2012; 1: 93–97 (in Russ.)].

4. Арсентьев В.Г., Асеев М.В., Баранов В.С. и др. Результаты молекулярно-генетического обследования детей с дисплазиями соединительной ткани. Педиатрия. 2013; 92 (4): 27–30 [Arsent’ev V.G., Aseev M.V., Baranov V.S. i dr. The results of molecular genetic research of children with dysplasia of connective tissue. Pediatriya. 2013; 92 (4): 27–30 (in Russ.)].

5. Czaprowski D., Kotwicki T., Pawłowska P. et al. Joint hypermobility in children with idiopathic scoliosis: SOSORT award 2011 winner. Scoliosis. 2011; 6: 22.

6. Кадурина Т.И., Гнусаев С.Ф., Аббакумова Л.Н. и др. Наследственные и многофакторные нарушения соединительной ткани у детей. Алгоритмы диагностики. Тактика ведения. Проект российских рекомендаций. Медицинский вестник Северного Кавказа. 2015; 10. (1):. 5–35 [Kadurina T.I., Gnusaev S.F., Abbakumova L.N. i dr. Heritable and multifactorial lesions of the connective tissue in children. Algorithms of the diagnostics. Management tactics. Project of the Russian recommendations. Meditsinskiy Vestnik Severnogo Kavkaza. 2015; 10 (1): 5–35 (in Russ.)].

7. Кадурина Т.И., Аббакумова Л.Н. Дисплазия соединительной ткани: путь к диагнозу. Вестник Ивановской медицинской академии. 2014; 19 (3): 5–11. [Kadurina T.I., Abbakumova L.N. Dysplasia of the connective tissue: the way to diagnosis. Vestnik Ivanovskoy meditsinskoy akademii. 2014; 19 (3): 5–11 (in Russ.)].

8. Аббакумова Л.Н., Арсентьев В.Г., Кадурина Т.И. и др. Полиорганные нарушения при дисплазиях соединительной ткани у детей. Алгоритмы диагностики. Тактика ведения. Проект российских рекомендаций. Педиатр. 2016; 7 (4): 5–38. [Abbakumova L.N., Arsent’ev V.G., Kadurina T.I. et al. Multiple organ disorders of the connective tissue dysplasia in children. Algorithms of the diagnostics. Management tactics. Project of the Russian recommendations. Pediatriya. 2016; 7 (4): 5–38 (in Russ.)].

9. Cappelli S., Bellando Randone S., Martinovic D. et al. “To Be or Not To Be,” ten years after: evidence for mixed connective tissue disease as a distinct entity. Semin. Arthritis Rheum. 2012; 41: 589–598.

10. Кадурина Т.И. Горбунова В.Н. Дисплазия соединительной ткани : руководство для врачей. СПб., 2009: 704. [Kadurina T.I., Gorbunova V.N. Dysplasia of the connective tissue : guideline for the physicians. St.-Peterburg, 2009: 704 (in Russ.)].

11. Курзина Е.А., Жидкова О.Б., Петренко Ю.В. и др. Характеристика дисплазий соединительной ткани у детей, перенесших тяжелую перинатальную патологию. Педиатрия. 2013; 92 (4): 31–36 [Kurzina Е.А., Zhidkova О.B., Petrenko Yu.V. i dr. The characteristic of the connective tissue dysplasia in children suffered after severe perinatal pathology. Pediatriya. 2013; 92 (4): 31–36 (in Russ.)].

12. Викторова И.А., Нечаева Г.И., Киселева Д.С. и др. Дисплазия соединительной ткани: особенности амбулаторного ведения пациентов в различных возрастных периодах. Лечащий врач. 2014; 9: 76. [Viktorova I.A., Nechaeva G.I., Kiseleva D.S. i dr. Dysplasia of the connective tissue: features of ambulatory treatment of patients in different age periods. Lechashchiy vrach. 2014; 9: 76 (in Russ.)].