Ожирение и дефицит массы тела как предикторы гестационной гипертензии и сердечно-сосудистых заболеваний

Abstract

Purpose of work. To reveal possible predictors of cardiovascular diseases on the basis of studying mechanisms of gestational adaptation, parameters of homeostasis in women with obesity and body weight deficiency. Material and methods. During pregnancy in 297 patients with changed body weight and 107 women of the comparison group carried out dynamic study of homeostasis parameters and adaptation mechanisms. The clinical state was assessed using morphological, electrophysiological, hormonal, biochemical and microbiological methods. Results. Analysis of anamnestic data revealed that parents of 87% of patients with obesity and weight deficit had arterial hypertension combined with atherosclerosis, obesity, diabetes mellitus, and depression. The upper distribution of subcutaneous tissue and gestational hypertension were found to be prevalent in women of the main clinical group: during the whole period, the average blood pressure was exceeded in obese women and in women with a deficit of body weight in the second trimester. General cholesterol level in the second trimester was increased due to atherogenic fractions in pregnant women of the first group up to 6.21 ± 0.13 mmol/l, in the second group – 5.95 ± 0.20 mmol/l, against the control group 4.96 ± 0.31 mmol/l. Transitor glucosuria (in case of excluded diabetes mellitus) occurred only in pregnant women with changed body weight in the 2nd trimester. Stress reactions prevailed in women with obesity and deficit of body weight on the eve of labor: 77% (1) and 88% (2), exceeding the parameters of the control group; there was also an increase in the level of norepinephrine and dioxyphenylalanine in daily excretion of urine by 4-6 times. Decrease in species landscape of intestinal and vaginal flora with increasing share of pathogenic microorganisms was registered in 91% of pregnant main groups and only in 33% of control group patients. Conclusion. In women with changed body weight, pregnancy is accompanied by excessive activation and disintegration of adaptation systems, the clinical equivalent of which is gestational hypertension, metabolic and microecology disorders. Gestational stress-test allows to estimate phylogenetic features of response systems of young women and probable ontogenetic risks of cardiovascular diseases.