Metabolic syndrome as a factor influencing the course of pregnancy
Background. According to the WHO guidelines, the criteria for metabolic syndrome (MS) include obesity (body mass index (BMI) >30 kg/m2), abdominal obesity (ratio of waist circumference and hips circumference >0.85 for females), blood pressure >160/90 mm Hg, triglyceride level >1.7 mmol/l, impaired glucose tolerance, microalbuminuria >20 μg/min.
Objective. To assess the impact of MS on pregnancy.
Materials and methods. Analysis of literature data on this issue and our own study involving 38 obese women. Pregnant women in the study were tested for pregnancy-associated protein A (PAPP-A), placental growth factor (PIGF), arginine, and leptin. They were also prescribed a comprehensive preventive treatment (from 12 weeks of pregnancy – 150 mg of aspirin 1 g per day, from 16 weeks – L-arginine solution (Tivortin aspartate, “Yuria-Pharm”) 5 ml (1 g) 4 times per day for 2 months). The control group consisted of 30 healthy pregnant women, the comparison group – of 30 obese pregnant women who did not receive L-arginine.
Results and discussion. The pathological consequences of the mother’s MS for the foetus are mediated by the insulin resistance, hyperglycemia, and vascular damage. The negative effects include birth injuries, caesarean section, childhood obesity, and cardiovascular disease. Eclampsia and preeclampsia (PE), which increase the risk of perinatal mortality, are also the important problems of modern obstetrics. The presence of obesity in pregnant women increases the likelihood of PE by 2-3 times. Pre-pregnancy BMI increase by 5-7 kg/m2 also doubles the risk. In addition to PE, obesity also increases the risk of gestational hypertension, premature birth, foetal growth retardation syndrome, macrosomia, gestational diabetes mellitus, sudden foetal death. Endothelial dysfunction (ED) is one of the main pathogenetic links of obstetric complications, primarily PE. Thus, hypertension in PE is a consequence of impaired endothelial control of vascular tone, proteinuria and oedema – of increased vascular permeability, coagulopathy – of overexpression of procoagulants. In obesity, the likelihood of PE increases as chronic inflammation and ED are induced. PE development is also mediated by the increase in the leptin concentration. Nitric oxide donors, namely L-arginine, should be prescribed to correct ED and prevent PE. According to the results of our own study, obese women in the first trimester had significantly higher leptin levels and significantly lower PIGF levels, which is a prerequisite for PE and other gestational complications. In the main group, compared to the comparison group, there was a lower frequency of early moderate PE (5 % vs. 8 %), early severe PE (1 % vs. 5 %), moderate PE after 34 weeks of pregnancy (8 % vs. 12 %), and severe PE after 34 weeks of pregnancy (1 % vs. 4 %).
Conclusions. 1. Obesity significantly increases the risk of PE and other gestational complications. 2. The main mechanisms of adverse effects of obesity are chronic inflammation and ED. 3. The use of complex prophylaxis with aspirin and L-arginine for 2 months almost 5 times reduced the degree of severe early PE.
This work is licensed under a Creative Commons Attribution 4.0 International License.