• Preeclampy prevention issues in women with obesity
en To content

Preeclampy prevention issues in women with obesity

HEALTH OF WOMAN. 2020.4(150): 61–66; doi 10.15574/HW.2020.150.61
 Posokhova S. P., Nikolaeva S. V., Nitoсhko K. O.
Odessa National Medical University

The objective: evaluation of the effectiveness of the prevention of preeclampsia in pregnant women with obesity using L-arginine during pregnancy
Materials and methods. Materials and methods. The main group consisted of 38 obese women (1st century – 15th, 2nd century – 12th, 3rd century – 11), who were prescribed complex prevention of preeclampsia: from 12 weeks of pregnancy 150 mg of aspirin once a day, and from 16 weeks the solution L-arginine (Тivortin aspartate) 5 ml (1 g) 4 times a day for 2 months. The comparison group included 30 pregnant women with obesity of the II-III stage who did not receive preventive treatment. The control group consisted of 30 healthy pregnant women.
By the beginning of prophylactic treatment and in the dynamics of all obese pregnant women, the level of pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PlGF), arginine and leptin was determined in blood serum.
Results. In pregnant women with obesity, already in the first trimester a significantly higher level of leptin is observed compared to the main group and the level of placental growth factor is significantly lower, which are significant triggers for the development of preeclampsia and other gestational complications. After the prophylactic treatment of pregnant women of the main group with L-arginine for 2 months (at 16–24 weeks), the following trends were observed: the level of L-arginine did not change, was constant. Leptin levels differed depending on the degree of obesity, but did not have a high critical value. A positive trend was the growth of placental growth factor in women of the main group, which indicated normal placentation and the prevention of early preeclampsia.
Conclusions. Thus, in pregnant women of the main group, after comprehensive prevention of the development of preeclampsia with aspirin and L-arginine (Тivortin) for 2 months, the incidence of severe severe preeclampsia decreased by 4.4 times, which is a favorable factor in maintaining a woman’s health and reducing perinatal losses. Additional L-arginine in the diet reduced the frequency of preeclampsia in pregnant women with obesity, contributing to vasodilation due to increased production of nitric oxide, may be one of the positive factors of pathogenetic treatment.
Keywords: pregnancy, obesity, preeclampsia, leptin, nitric oxide, L-arginine.

REFERENCES

1. Zelinka-Khobzei MM, Tarasenko KV. 2019. Endotelialna dysfunktsiia yak patohenetychna osnova akusherskykh uskladnen u vahitnykh z ozhyrinniam (ohliad literatury). Visnyk problem biolohii i medytsyny. Vyp. 1. 2(149):34–40. https://doi.org/10.29254/2077-4214-2019-1-2-149-34-40

2. Karelina OB, Artyimchuk NV. 2017. Osobennosti soderzhaniya leptina u beremennyih s ozhireniem i ih novorozhdennyih. Fundamentalnaya i klinicheskaya meditsina 2;3:21–27.

3. Linde VA. 2015. Problema preeklampsii daleka ot svoego resheniya. Rossiyskiy vestnik akushera-ginekologa 2:10–11.

4. Melnik AA. 2019, cherven. Prognosticheskie biohimicheskie markeryi preeklampsii. Tematichniy nomer «GInekologIya, Akusherstvo, ReproduktologIya» 2(34):42–44.

5. Radyinova SB, Ivanova EA. 2018. Oslozhneniya beremennosti i rodov u zhenschin s ozhireniem. Sovremennyie problemy nauki i obrazovaniya 5:15–18.

6. Chabanova NB, Vasilkova TN, Polyakova VA. 2019. Vliyanie massyi i haraktera raspredeleniya zhirovoy tkani na soderzhanie lipina u beremennyih v razlichnyie sroki gestatsii. Ozhirenie i metabolizm 1:55–61.

7. Yusupova ZS, Novikova VA, Olenev AS. 2018. Sovremennyie predstavleniya o preeklampsii – patogenez, diagnostika, prognozirovanie. Prakticheskaya meditsina 16(6):45–51. https://doi.org/10.32000/2072-1757-2018-16-6-45-51

8. Carlhäll S, Bladh M, Brynhildsen J et al. 2016. Maternal obesity (Class I-III), gestational weight gain and maternal leptin levels during and after pregnancy: a prospective cohort study. BMC Obes. 3:28. Published online 2016 May 20. https://doi.org/10.1186/s40608-016-0108-2; PMid:27257506 PMCid:PMC4875677

9. Eissa AN, Sayyed TM, El-Bagoury AS. 2019. Role of serum leptin as a marker of severity of pre-eclampsia. Menoufia Med J. 32:470-5. https://doi.org/10.4103/mmj.mmj_97_18

10. Matthew Gormley, Katherine Ona, Mirhan Kapidzic. 2017. Preeclampsia: novel insights from global RNA profiling of trophoblast subpopulations. American Journal of Obstetrics and Gynecology 217(2):200-203. https://doi.org/10.1016/j.ajog.2017.03.017; PMid:28347715

11. Mittal M, Kulkarni CV, Panchonia A, Mittal RK. 2014. Evaluation of serum lipid profile in cases of preeclampsia and eclampsia. Int. J. Reprod. Contracept. Obstet. Gynecol. 3(3):732-4. https://doi.org/10.5455/2320-1770.ijrcog20140981

12. Moustafa I, Ibrahim, Hayam F Mohammad, Manar L Younis Ch. 2019. Effect of L-Arginin on Intrauterine Growth Restriction fetuses Measured by Birth weight a Randomised Controlled Trial. Nat Sci. 17(12):158-166.

13. Patricio Lopez-Jaramillo, Juan Barajas, Sandra M Rueda-Quijano et al. 2018. Obesity and Preeclampsia: Common Pathophysiological Mechanisms. Front Physiol. 9:18-38. https://doi.org/10.3389/fphys.2018.01838; PMid:30618843 PMCid:PMC6305943

14. Santos S, Voerman E, Amiano P et al. 2019. Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts. BJOG 126:984.

15. Tessier DR, Ferraro ZM, Gryslin A. 2013, Mar. Role of leptin in pregnancy: Consequences of maternal obesity. Placenta 34(3):205-11. https://doi.org/10.1016/j.placenta.2012.11.035; PMid:23332215

16. WHO report. Obesity and overweight. Fact sheet 311. 2014.

17. Zera CA, Seely EW, Wilkins-Haug LE et al. 2014. The association of body mass index with serum angiogenic markers in normal and abnormal pregnancies. Am J Obstet Gynecol 211:247.e1. https://doi.org/10.1016/j.ajog.2014.03.020; PMid:24631439