Взаємозв’язок акушерської патології з метаболічними порушеннями у вагітних жінок з ожирінням

Abstract

Мета дослідження - проаналізувати кореляційні зв’язки між характером і частотою акушерських ускладнень та метаболічними порушеннями у вагітних жінок з ожирінням залежно від ступеня тяжкості. У вагітних жінок з ожирінням частота акушерської патології тісно корелює з метаболічними порушеннями, ключову роль серед яких відіграє прогресування інсулінорезистентності залежно від ступеня ожиріння та ініційовані нею патологічні зміни функціонального стану печінки.; Цель исследования - проанализировать корреляционные связи между характером и частотой акушерских осложнений и метаболическими нарушениями у беременных женщин с ожирением в зависимости от степени тяжести.

У беременных женщин с ожирением частота акушерской патологии тесно коррелирует с метаболическими нарушениями, ключевую роль среди которых играет прогрессирование инсулинорезистентности в зависимости от степени ожирения и инициированные ею патологические изменения функционального состояния печени.; Pregnancy and parturition in women with obesity is characterized with high risk of obstetric and perinatal complications compared to those in women with normal body mass.

The aim of the present study was to analyze correlations between nature and frequency of obstetric complications and metabolic disorders in pregnant obese women depending on severity of obesity.

We examined 369 women aged 17-35 in the first and third trimester of pregnancy. Of them 268 pregnant women of obesity classes I, II and III were in the study group. The controls were 101 women with normal body mass. The obesity classes of the pregnant women were assessed with the method by N. S. Lutsenko.

The following metabolic indices were assessed in the women of the control group and the study group (I, II and III classes of obesity) in the third trimester of pregnancy: HOMA-IR and CARO indices of insulin resistance, numbers of functioning p-cells in the pancreas, blood plasma concentrations of insulin, cortisol, high sensitivity C-reactive protein (hs-CRP) and leptin were assayed with respective ELISA methods, blood plasma glucose concentration was measured with glucose oxidase method. The state of the hepatobiliary system was assessed with activities of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT) in blood plasma that were assayed with respective kinetic colorimetric methods, and the AST/ALT ratio. The blood lipid spectrum was assessed with blood plasma concentrations of total cholesterol, cholesterol of very low density lipoproteins (VLDL), cholesterol of high density lipoproteins (HDL), and triacylglycerols that were measured colorimetrically with respective enzymic methods. The atherogenic coefficient (AC) was calculated with the formula: AC = (total cholesterol - HDL cholesterol) / (HDL cholesterol). Spearman correlations were calculated.

It was found that frequency of obstetric complications increases in obese women depending upon severity of obesity. To elucidate a pathogenetic role of metabolic disorders in progression of obstetric pathology, we performed a correlation analysis of dependence of pregnancy complications on the indices of insulin resistance, the state of the hepatobiliary system and the blood lipid spectrum. We found that the leading role in development of obstetric complications in pregnant women of class I obesity belongs to metabolic disorders. Insulin resistance together with changes of the hepatobiliary system initiated by it, and weakened mechanisms of immune protection make a pathogenetic ground for the metabolic disorders. Development of obstetric complications in pregnant women of class II obesity is mostly due to a disordered state of the liver initiated by the progression of insulin resistance, that was indicated by a significant 2,7-fold increase of the HOMA-IR index and a 2,3-fold decrease of the CARO index and promotes energy deficiency of tissues. At the most severe obesity grade obstetric complications correlate both with progression of insulin resistance and disorders of the functional state of the liver

Thus, a close association of obstetric pathology and metabolic disorders is observed in pregnant women with obesity. The key role in the metabolic disorders belongs to progression of insulin resistance depending on the obesity grade together with pathologic changes of the functional state of the liver initiated by insulin resistance.