The Impact of Gestational Weight Gain on Subclinical Atherosclerosis, Placental Circulation and Neonatal Complications

Abstract

Objective: Vascular atherosclerotic changes, mediated by environmental and genetic factors, develop years before an event. Detection of vascular damage, using ultrasonographic measurement of carotid IMT, is predictive of future cardiovascular events. The present study was designed to investigate the impact of gestational weight gain (GWG) on early atherosclerotic changes during late pregnancy, using intima media thickness (IMT), as well as placental vascular circulation and inflammatory lesions and pregnancy outcome. Design and methods: 59 women who gave birth at Wolfson Medical Center during 2018 were divided into two groups according weight gain during pregnancy: Group 1 included 32 women with pregnancy weight gain within recommended range, Group 2 included 27 wonen with exessive weight gain during pregnancy. IMT was measured by High-resolution B-mode ultrasound (Sonosite Titan/Sonosite, Inc., Bothell, Washington, USA). Placental histology was performed for vascular circulation, as well as inflammatory lesions of maternal and fetal origin. Metabolic measures such as fasting glucoe, lipids, hs-CRP, HOMA-IR were determined. Maternal and neonatal outcome parameters were collected. Results: Weight gain during the pregnancy was significantly higher in Group 1, compared to Group 2 (17.5+/-6.2 vs 6.8+/-5.7, p<0.0001), whereas pre-gestational BMI did not differ significantly between groups (p=0.059). IMT levels differed between groups and was significantly higher in group 1 compared to Group 2 (0.7+/-0.1 vs 0.6+/-0/1, p=0.028). In regression analisys, pregnancy weight gain remained a significant independent predictor of IMT. Rate of macrosomia was significantly higher in Group 1 than in Group 2 (p=0.014). Maternal vascular supply (MVS) abnormalities of the placental bed did not differ significantly between groups (p=0.297). Among placental lesions related to fetal vascular malperfusion, villous changes consistent with fetal thrombo-occlusive disease (FTOD) were significantly higher in Group 1 than in group 2 (p=0.034). Conclusion: In the present study, excessive weight gain during pregnancy was significantly and independently associated with an increased IMT. Among placental vascular lesions, villous changes consistent with fetal thrombo-occlusive disease (FTOD) were significantly higher women with excessive weight gain during pregnancy.