Особливості перебігу вагітності та характеристика акушерської патології у жінок з ожирінням різного ступеня та фізіологічною масою тіла

Abstract

The medical and social significance of obesity in pregnant women lies in the high frequency of obstetric complications: miscarriage, preeclampsia, placental dysfunction, abnormal labor, obstetric hemorrhages, infectious and extragenital diseases in offspring that are programmed in utero. The purpose of the research was to analyze the course of pregnancy and to characterize obstetric pathology in women with obesity of various degrees and physiological body weight. Material and methods. To achieve this goal, we surveyed 369 pregnant women. Pregnant women with obesity were divided into three experimental groups: the first one consisted of 149 women with obesity of the 1st degree; the second group included 73 women with the 2nd degree obesity; the third group had 46 women with the 3rd degree obesity. The control group consisted of 101 women with physiological body weight (BMI = 18.5-25 kg/m2). Results and discussion. In the early term of pregnancy, the risk of miscarriage in women with obesity of different degrees was reliably higher by 2.1-2.9 times compared to the control group (p˂0.05). The risk of late miscarriage in groups of women with obesity of different degrees was 1.7-2.4 times higher than in the control group, although these differences were unreliable. There was also a clear tendency for the risk of preterm labor to increase by 1.4-1.7 times (p˃0.05) in obese women. There was a significant increase in the frequency of placental dysfunction in pregnant women with obesity of varying degrees, which was 1.3-1.8 times higher than the control values. An increase in the incidence of placental dysfunction in obese pregnant women manifested as an increase in the number of cases of fetal distress during pregnancy, the frequency of which increased in accordance with the severity of obesity. There was an increase in the incidence of early preeclampsia without statistical significance in women with the 2nd and 3rd degree obesity. Regarding preeclampsia, a significant increase in its frequency should be noted in obese pregnant women depending on the severity. Only women with 2nd and 3rd degree obesity had obstetric hemorrhage caused by premature detachment of the normally situated placenta. This complication was not observed in pregnant women of the control group and with the I degree obesity. Anemia of pregnancy was 1.5 times more common in women with I degree obesity and 1.4 times in women with the 2nd degree obesity, compared to the control group. In obese pregnant women, the frequency of asymptomatic bacteriuria increased in the 1st degree obesity by 1.6 times, in the 2nd and 3rd degrees by 1.2 and 1.4 times respectively compared to the control group. Conclusion. Thus, obesity is an aggravating factor of pregnancy, as evidenced by the increasing frequency of the most threatening complications for the mother and fetus such as miscarriage, placental dysfunction, preeclampsia, and obstetric hemorrhage compared to pregnant women with physiological body weight