Risk factors for complications of perinatal pathology in overweight and obese pregnant women
The objective. To determine risk factors for development of perinatal pathology in overweight and obese pregnant women.
Patients and methods. The examination included 106 pregnant women, who were observed from the moment of registration in a maternity centre until childbirth (at terms from the 6th to 41st week). All the patients were divided into 2 groups: basic (n = 82) and control ones (n = 24). The control group included women with initial normal body mass index (BMI) 18–24.9 kg/m2, the basic group – women with initial BMI ≥ 25 kg/m2. All women were included into the study in the 1st trimester of gestation and followed up during the whole period of gestation, their perinatal outcomes were assessed after childbirth. A standard set of diagnostic methods was used, supplemented by detection of microalbuminuria (MAU). US examinations in the 2–3rd trimesters comprised fetometry, placentography, assessment of the quality and amount of amnionic fluid, Doppler assessment of blood flow in the uterine artery (UtA), umbilical artery (UmA), fetal aorta (Ao), fetal middle cerebral artery (MCA) according to conventional methods. Newborn infants (total number – 105 infants, taking into account one stillbirth and absence of multiple births) underwent postnatal anthropometry and Apgar scoring.
Results. We obtained correlations of different strengths between the development of IUGR and health indices of a pregnant woman. The strongest direct significant correlational relationship was obtained with the value of weight increment during pregnancy, dynamics of renal function and development of preeclampsia in the course of pregnancy. The degree of MAU growth during pregnancy increases the risk for developing preeclampsia (OR = 0.537, CI 95% [0.297–0.971]) and IUGR (β = 0.47 ± 0.12, p < 0.0001). Apgar scores in the 1st and 5th minutes of life are significantly influenced only by body mass increment during pregnancy (r = –0.38, p < 0.05 and r =–0.26, p < 0.05). In pregnant women of the control group, the level of protein loss with urine during the whole period of gestation does not exceed the allowable norm of 25 mg/l. In pregnant women of the basic group, an increase of MAU levels with the increasing term of gestation was observed. MAU levels of 45 mg/l and more in the first trimester is an early prognostic marker of placental insufficiency with a high degree of accuracy. Pregnant women with MAU levels of 60 mg/l and more in the first trimester should be referred to a risk group for development of preeclampsia. Prior to development of the clinical symptoms of preeclampsia, a latent phase could be observed (lasting to 2 weeks), when MAU levels sharply increased, which might serve as one of prognostic tests for development of preeclampsia. The Apgar score assessment of the state of a newborn child is most greatly influenced by a mother’s body mass increment during pregnancy and preeclampsia.
Conclusion. In our study, the most significant predictors of development of IUGR were factors that characterize a complicated course of pregnancy. Detection of MAU levels, change of body mass increment during pregnancy along with early diagnosis of preeclampsia are an easy-to-employ, safe and cost-efficient method that is helpful for evaluating the endothelial function in pregnant women with metabolic syndrome.
Key words: pregnancy, BMI, microalbuminuria, Apgar score, preeclampsia, IUGR