Abstract
Background and Objectives: obesity and blood pressure disorders are one of the main risk factors for antenatal, intra, postpartum, and neonatal complications. In preeclampsia (PE), the placental hypoxia leads to vascular endothelium dysfunction, cell necrosis, and apoptosis. This condition is associated with the release of free fetal DNA (cffDNA) circulating in plasma. The disturbance of the efficiency of vasodilatation and blood pressure regulation in PE can be confirmed by analyzing the apelin, salusin, and prosalusin. This study aimed to assess the influence of obesity on cffDNA, and the effectiveness of maintaining normal blood pressure in patients with preeclampsia and gestational hypertension. Material and Methods: the research material was blood serum and oral mucosa swabs, obtained from 168 patients. Pregnant women were divided into the following: a control group (C)—67 women; a gestational hypertension group (GH)—35 patients; a preeclampsia with obesity group (PE + O) (pre-gravid BMI > 30)—23 patients. The rest were lean preeclamptic women (PE)—66 patients—(pre-gravid BMI < 25 in 43 women). Results: the cffDNA was observed in 1.50% of women in the C group, in 2.45% in the GH group, but in 18.18% of lean patients with preeclampsia. The cffDNA was detected in 58% of obese pregnant women with PE. The greater the placental hypoxia was in preeclampsia, the less efficient the hypotensive mechanisms, according to an analysis of the studied adipokines. The prosalusin concentration was significantly lower in the PE group with cffDNA than in the PE group without it (p = 0.008). Apelin was higher in the PE group with cffDNA (p = 0.006) compared to other groups. The same results were also observed in the subgroup with obesity. Conclusion: in preeclamptic women, obesity seems to act as an additive factor of placental damage by means of the dysregulation of hypotensive mechanisms.
Highlights
Obesity in pregnant women is associated with a significant risk of gestational diabetes, blood pressure disturbance, fetal growth restriction or over nutrition, birth complications and an increased number of caesarean sections
This study aimed to determine if obesity could influence the percentage of cffDNA in preeclamptic women, and if this effect could be mediated by the disturbance of hypotensive mechanisms
The pregnant women hospitalized between 2008 and 2015 in the Department of Obstetrics and Pathology of Pregnancy in Lublin, Poland were divided into groups: a control group (C) with 67 pregnant women, a gestational hypertension group (GH) with 35, and group with preeclampsia (PE) with 66 patients
Summary
Obesity in pregnant women is associated with a significant risk of gestational diabetes, blood pressure disturbance, fetal growth restriction or over nutrition, birth complications and an increased number of caesarean sections. A high body mass index (BMI) in pregnant women may reduce the chance of effective screening (traditional serum analysis and ultrasound). For this reason, the multifactorial prognostic tests are the most effective option for the anticipation of particular pregnancy complications. In preeclampsia (PE), the placental hypoxia leads to vascular endothelium dysfunction, cell necrosis, and apoptosis This condition is associated with the release of free fetal DNA (cffDNA) circulating in plasma. This study aimed to assess the influence of obesity on cffDNA, and the effectiveness of maintaining normal blood pressure in patients with preeclampsia and gestational hypertension. Results: the cffDNA was observed in 1.50% of women in the C group, in 2.45% in the GH group, but in 18.18% of lean patients with preeclampsia. Conclusion: in preeclamptic women, obesity seems to act as an additive factor of placental damage by means of the dysregulation of hypotensive mechanisms
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