Email this article Early prediction of placental insufficiency in obese women
- Authors: Datsenko N.S.1, Marinkin I.O.1, Sokolova T.M.1, Kiseleva T.V.1, Yakimova A.V.1
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Affiliations:
- Novosibirsk State Medical University of the Ministry of Health of Russia
- Issue: Vol 8, No 1 (2021)
- Pages: 40-47
- Section: Original study articles
- URL: https://archivog.com/2313-8726/article/view/63318
- DOI: https://doi.org/10.17816/2313-8726-2021-8-40-47
- ID: 63318
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Abstract
Obesity is one of the most important problems in modern health care. The high prevalence of this pathology also affects women of reproductive age, which leads to an increase in the prevalence of obesity in pregnant women.
Purpose of the work ‒ analysis of the effect of adipokine indicators on predicting the development of placental insufficiency in obese women.
Materials and methods. 225 women were examined who were subdivided by such a parameter as obesity into 4 groups: 3 main and 1 control. The control group consisted of 55 pregnant women with an initially normal BMI value (18.5‒24.9 kg/m2). Group 1st included 109 pregnant women with grade I obesity (BMI 31.88 ± 1.4 kg/m2), group 2nd ‒ 34 pregnant women with grade II obesity (BMI 36.6 ± 1.1 kg/m2), group 3rd ‒ 31 pregnant women with grade III obesity (BMI 42.2 ± 1.9 kg/m2).
We studied the data of the anamnesis of pregnant women (somatic and obstetric-gynecological), indicators of adiponectin and omentin, peculiarities of the course of pregnancy and childbirth (data of cardiotocography (CTG), ultrasound markers of disturbances in the formation and functioning of the fetoplacental complex), indicators of labor activity, parameters of newborns (mass-growth, state on the Apgar scale, ponderal index, fetal-placental ratio) and the course of the postpartum period.
When conducting statistical analysis in the case of comparing two dependent (paired) samples of parameters, the paired Student’s t-test was used.
The results were considered statistically significant if the р was less than 0.05. With this indicator, the value of the probability of difference between the compared categories was more than 95%.
Results. The possibility of predicting the development of placental insufficiency depending on the concentrations of omentin and adiponectin was confirmed. The development of placental insufficiency is most likely with omentin values in the range of 177.6‒191.2 μg/ml and adiponectin in the range of 16.0‒22.5 μg/ml.
Conclusion. Determination of adipokine levels at 8‒9 weeks gestation may be practically significant in predicting the development of placental insufficiency in obese women.
Keywords
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Introduction
Over the past 30 years, the global rates of obesity in all population groups have exponentially increased, including pregnant women and children [1].
The incidence of obesity has obvious demographic differences [2], and the prevalence of maternal obesity is largely associated with social, educational, and ethnic differences [3–6].
The researchers revealed that women with obesity are at a greater risk of maternal and fetal complications during pregnancy and childbirth than women with a normal body mass index (BMI). The risk of antenatal, intranatal, postnatal, and neonatal complications increases including hypertensive disorders, gestational diabetes mellitus, venous thromboembolism, preterm labor, fetal macrosomia, and unexplained stillbirth [7–11].
Additionally, children born to mothers with obesity are at an increased risk of metabolic disorders, as well as neuropsychiatric and cognitive disorders.
The chronic inflammatory process in women with obesity during pregnancy triggers a cascade of reactions that ultimately lead to pro-inflammatory intrauterine environment formation.
The placentas of pregnant women of this category registered a significant macrophage infiltration. Macrophages secrete pro-inflammatory cytokines and adipokines, including interleukin-6, leptin, tumor necrosis factor-alpha, monocytic chemotactic protein-1, adiponectin, and omentin [12].
Pro-inflammatory cytokines suppress placental cellular respiration, which contributes to the development of hypoxia, accompanied by increased transport of free fatty acids, which affects fetal growth and development.
Particular attention is currently paid to adiponectin and omentin [13].
Adiponectin plays a critical role in the regulation of immune response, metabolism, and placental insulin sensitivity. Its concentration in pregnant women with a normal BMI is higher than those with obesity throughout pregnancy. Concurrently, the concentration of adiponectin is inversely proportional to the fetal length, which indicates the role of this substance in metabolism and placental function regulation.
The omentin level has an inverse relationship with BMI and a direct correlation with adiponectin.
Therefore, the study of adiponectin and omentin indicators in pregnant women with obesity is of particular relevance in predicting placental insufficiency development.
This study aimed to analyze the possibility of the influence of adipokines on placental insufficiency development in women with obesity.
Materials and methods
A total of 225 women were examined and were distributed into four groups (three main groups and one control group) according to the BMI during pregnancy.
The control group included 55 pregnant women with a normal BMI (18.5–24.9 kg/m2).
Pregnant women with obesity were distributed into three groups. Group 1 included 109 pregnant women with a degree I obesity (BMI of 31.9 ± 1.4 kg/m2), group 2 included 34 pregnant women with a degree II obesity (BMI of 36.6 ± 1.1 kg/m2), and group 3 included 31 pregnant women with degree III obesity (BMI of 42.2 ± 1.9 kg/m2).
Table 1 shows the comparative characteristics of the age aspects of the studied groups.
Table 1
The age characteristics of the studied groups
Age, years | Group 1 (n = 105), n (%) | Group 2 (n = 34), n (%) | Group 3 (n = 31), n (%) | Control group (n = 55), n (%) |
18‒24 | 20 (19.1) | 4 (11.8) | 2 (6.5) | 14 (25.6) |
25‒31 | 39 (37.1) | 15 (44.1) | 6 (19.3) | 25 (45.4) |
32‒39 | 46 (43.8) | 15 (44.1) | 23 (74.2) | 16 (29) |
Average age, years | 30.3 | 30.0 | 33.5 | 28.5 |
According to the presented data, no significant differences were found in age between the groups. All participants were of reproductive age. Group 3 has more pregnant women aged 32‒39 years, whereas aged 25‒31 years in the control group.
Diagnosis verifications, as well as patient monitoring, were conducted following the national recommendations and guidelines of the World Health Organization. The anamnesis data of pregnant women (somatic and obstetric-gynecological) were studied, as well as adiponectin and omentin levels, the characteristics of pregnancy and childbirth course (cardiotocography [CTG] data, ultrasound markers of impaired formation, and fetoplacental complex functioning), labor activity indicators, newborn parameters (weight and length, Apgar scale scoring, ponderal index, and fetal-placental coefficient), and the postpartum period course.
A paired Student’s t-test was used for statistical analysis to compare two dependent (paired) samples of parameters.
The results were considered significantly significant at a p-value of < 0.05. With this indicator, the value of the probable difference between the compared categories was > 95%.
Results
Table 2 shows the blood plasma adipokine level at a gestational age of 8–9 weeks.
Table 2
The comparative characteristics of adiponectin and omentin concentrations, µg/ml
Indicator | Group 1 (n = 105) | Group 2 (n = 34) | Group 3 (n = 31) | Control group (n = 55) |
Adiponectin before childbirth | (25.8 ± 13.1)* | (22.5 ± 12.2) | (16.0 ± 7.1)** | (28.3 ± 12.6)* |
Omentin | (309.3 ± 15.5) | (191.2 ± 9.6)* | (177.6 ± 8.9)** | (343.3 ± 17.2) |
Note. Significance of differences between groups: *p ≤ 0.05; **p ≤ 0.01.
The analysis of prenatal adiponectin concentrations indicates their decrease with an increased BMI since the highest indicator in the control group was 28.3 ± 12.6 μg/ml and the lowest indicator in group 3 was 16.0±7.1 μg/ml (p ≤ 0.01).
Patients with obesity had significantly lower serum omentin concentrations compared to the control group (p ≤ 0.05; p < 0.01).
This study analyzed the anamnesis data, pregnancy course indicators, labor activity parameters, newborn parameters, postpartum period complications, and CTG results (Fig. 1).
Fig. 1. The characteristics of the course of pregnancy in women with obesity.
These data indicate that complications, such as proteinuria, preeclampsia, and polyhydramnios, were more often significantly recorded (p ≤ 0.05) in group 3. Additionally, women in this group showed an increased tendency to edema.
The analysis of the amniotic fluid revealed that the vast majority of female patients in the studied three main groups had light amniotic fluid. Meconium fluid was not registered in the control group, while noted in 15.2% of cases in group 1, 20.6% in group 2, and 12.90% in group 3 (p > 0.05).
The obtained data indicated that childbirth was the most physiological in the control group, whereas the frequency of natural childbirth decreased in the main groups, amounting to the smallest number in group 2 (11.8%; p < 0.05).
The frequency of emergency cesarean section was 18.2% in the control group (Fig. 2), with the largest number verified in patients with degree II obesity, namely in 47.1% of cases (p < 0.05).
Fig. 2. The aspects of labor activity in women with obesity compared with the control group.
Analysis of data on blood loss during childbirth is presented in Figure 3.
Fig. 3. Blood loss during childbirth in women of the studied groups.
Significantly greater blood loss (p ≤ 0.05) was registered in group 3 (348.7 ± 17.4 ml) compared with groups 1 and 2 (278.6 ± 13.9 and 273.5 ± 13.7 ml, respectively) and the control group (181.8 ± 9.1 ml).
Table 3 shows the comparative characteristics of the weight and length newborn indicators of the studied groups.
Table 3
The comparative characteristics of weight and length parameters of newborns
Indicator | Group 1 (n = 105) | Group 2 (n = 34) | Group 3 (n = 31) | Control group (n = 55) |
Weight, g | 3327.3 ± 166.4 | 3350.8 ± 167.5 | 3427.3 ± 171.4 | 3119.7 ± 156.0 |
Body length, cm | 50.9 ± 2.6 | 51.5 ± 2.6 | 51.9 ± 2.6 | 49.7 ± 2.5 |
Figure 4 shows the comparative characteristics of newborns in the studied groups (% ratio).
Fig. 4. The characteristics of newborns in women of the studied groups.
The newborn status analyses compared the number of children with an Apgar score of 7 in the study groups (the remaining ones have scores of > 7 points). The number of newborns with an Apgar score of 7 points was significantly higher in women with obesity compared with the control group, with a maximum number (16.1% of cases) revealed in the children of group 3.
Birth injuries were recorded in 1.8% of newborns in the control group, 3.8% in group 1, 8.8% in group 2, and 22.6% in group 3. Birth injuries were not observed in 98.2% of the control group, 96.2% in group 1, 91.2% in group 2, and 77.4% in group 3.
The above data indicate that this complication was most often recorded in group 3 (p < 0.05).
The fetal-placental coefficient was within the normal range in the control group. The greatest decrease in this coefficient (p ≤ 0.05) was registered in group 3, which indicates a circulatory-metabolic balance disorder of the fetoplacental system.
Figure 5 shows the comparative characteristics of postpartum period complications in women of the studied groups (% ratio).
Fig. 5. Postpartum period complications in women of the studied groups.
The analyses of the main reproductive system complications after childbirth revealed that uterine subinvolution, endometritis, and lochiometra were more common in women with obesity compared to that of the control group, with a significantly higher number of cases (p ≤ 0.05) in group 3. These complications were noted in single cases in the control group.
Figure 6 shows the comparative characteristics of CTG data in the studied groups (% ratio).
Fig. 6. Сardiotocography findings in women of the studied groups.
Normal CTG parameters in the absolute majority were registered in 96.4% of the control group, 90.5% in group 1, 85.3% in group 2, and 74.2% in group 3.
Doubtful CTG data were recorded in 9.5% of cases in group 1, 14.7% in group 2, and 16.1% in group 3. Additionally, pathological parameters of CTG were registered in 9.7% of cases in group 3 (p ≤ 0.05).
Table 4 presents the comparative characteristic of ultrasonic markers of impaired fetoplacental complex formation and functioning.
Table 4
The comparative characteristics of ultrasonic markers of disorders in the formation and functioning of the fetoplacental complex
Indicator | Group 1 (n = 105), n (%) | Group 2 (n = 34), n (%) | Group 3 (n = 31), n (%) | Control group (n = 55), n (%) |
Placental hypertrophy as compensatory changes in placental insufficiency | 7 (6.7) | 8 (23.5)* | 8 (29.0)** | 1 (1.8) |
Hypoplasia of the placenta | ‒ | ‒ | 1 (3.2)** | ‒ |
Expansion of the intervillous space and degenerative changes in the placenta (compensatory and adaptive changes in placental insufficiency) | 13 (12.4) | 7 (20.6)* | 11 (35.5)** | 1 (1.8) |
Oligohydramnios | 9 (8.6) | 6 (17.7) | 12 (38.7) | ‒ |
Note. Significance of differences between the groups: *p ≤ 0.05; **p ≤ 0.01.
The obtained data indicate that the most common manifestations of compensatory changes in placental insufficiency (in the form of placental hypertrophic changes, intervillous space expansion, and placental degenerative changes) were detected in group 3.
Figures 7 and 8 present the prediction of placental insufficiency in graphical terms depending on the omentin and adiponectin values.
Fig. 7. Blood serum omentin level in women with obesity at a gestational age of 8–9 weeks.
Fig. 8. Blood serum adiponectin level in women with obesity at a gestational age of 8–9 weeks.
The development of placental insufficiency is most probable with omentin values in 177.6–191.2 μg/ml and adiponectin level in 16.0–22.5 μg/ml at a gestational age of 8–9 weeks.
Discussion
Overweight women have a 2–3 times higher risk of obstetric complications, of which the possible development of fetoplacental insufficiency is of great importance, resulting in placental pathology and fetal development disorders [16–20].
The close attention of obstetrician-gynecologists and endocrinologists is paid to the etiopathogenetic aspects of the development of gestational complications in metabolic disorders, which are associated with imbalanced adipokines in maternal obesity [21–23]. The role of adiponectin and omentin as the main parameters that characterize the degree of obesity in pregnant women is of great significance.
Authors of recent studies have paid great attention to prognostic model development for various pathologies in pregnant women, with high diagnostic sensitivity, specificity, and efficiency for a successful practical application [24‒27].
Our study analyzed the possibility of developing placental insufficiency in pregnant women with obesity in the gestational age of 8–9 weeks, depending on the blood serum omentin and adiponectin concentrations.
The most probable parameters that characterize pregnant women with obesity, with omentin and adiponectin levels corresponding to each degree of obesity in trimester I of pregnancy, include the following:
1) an increased probability of somatic pathology (thyroid gland pathology), gynecological diseases (uterine fibroids);
2) an increased probability of complications during pregnancy (proteinuria, edema, preeclampsia, and polyhydramnios);
3) the verification of ultrasound markers of fetoplacental complex dysfunction, such as placental hypertrophy, placental hypoplasia, intervillous space expansion, and placental degenerative changes;
4) an increased probability of fixing doubtful and pathological records during CTG;
5) a large blood loss during childbirth;
6) increased risk of newborn injury during childbirth;
7) a decreased fetal-placental coefficient value (up to 0.180);
8) an increased ponderal index value.
Conclusion
Determining the probability of placental insufficiency depending on the blood plasma adiponectin levels, when used in practice, is a new diagnostic tool that contributes to the timely prediction of placental insufficiency development in women with obesity.
About the authors
Natalya S. Datsenko
Novosibirsk State Medical University of the Ministry of Health of Russia
Author for correspondence.
Email: Datsenko.natasha@yandex.ru
assistant
Russian Federation, 630091, NovosibirskIgor O. Marinkin
Novosibirsk State Medical University of the Ministry of Health of Russia
Email: rectorngmu@yandex.ru
ORCID iD: 0000-0002-9409-4823
Doctor of Medical Sciences, Professor
Russian Federation, 630091, NovosibirskTat’yana M. Sokolova
Novosibirsk State Medical University of the Ministry of Health of Russia
Email: Tatyana39655@mail.ru
ORCID iD: 0000-0003-3435-3536
Doctor of Medical Sciences, Professor
Russian Federation, 630091, NovosibirskTat’yana V. Kiseleva
Novosibirsk State Medical University of the Ministry of Health of Russia
Email: kis_tv98@mail.ru
Doctor of Medical Sciences, Professor
Russian Federation, 630091, NovosibirskAnna V. Yakimova
Novosibirsk State Medical University of the Ministry of Health of Russia
Email: a.yakimova2@yandex.ru
Doctor of Medical Sciences, Professor
Russian Federation, 630091, NovosibirskReferences
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