Role of a comprehensive pregravid preparation program for obese women in the prevention of gestational complications
Objective. To determine the effectiveness of a comprehensive pregravid preparation program on the basis of studying the features of the course of pregnancy in obese women.Makarova E.L., Olina A.A., Terekhina N.A.
Subjects and methods. Examinations were made in 118 reproductive-aged women who were permanent residents in the city of Perm. A study group consisted of 36 patients who underwent a comprehensive pregnancy preparation program (diet therapy, replenishment of macro- and micronutrients: vitamin D3, folic acid, iodine, iron, and an anti-obesity drug combination of sibutramine + metformin). Comparison and control groups included women who were unprepared for pregnancy: the comparison group comprised 62 obese patients; the control group consisted of 20 non-obese women.
Results. The study group showed an 8.3% weight loss. No reproductive losses were recorded in this group. It was established that threatened miscarriage was diagnosed in 10/32 (34.4%) patients who had received no pregravid preparation and in 7/36 (19.4%) women of the study group. During pregnancy, gestational diabetes mellitus developed in 16/32 (50%) women of the comparison group and in 4/36 (11.1%) women of the study group.
Placental insufficiency was detected in 8/36 (22.2%) patients who had received pregravid preparation and in 20/32 (62.6%) who had not.
Conclusion. The program proposed by the authors for pregravid preparation with the anti-obesity combination medication Reduxin Forte (especially for women with visceral abdominal obesity), vitamin D3, iodine, and folic acid and their recommendations for lifestyle modification significantly prevent gestational complications.
Keywords
pregravid preparation
pregnancy
obesity
sibutramine
metformin
gestational diabetes mellitus
miscarriage
placental insufficiency
References
- Chavarro J.E., Toth T.L., Wright D.L., Meeker J.D., Hauser R. Body mass index in relation to semen quality, sperm DNA integrity, and serum reproductive hormone levels among men attending an infertility clinic. Fertil. Steril. 2010; 93(7): 2222-31. https://dx.doi.org/10.1016/j.fertnstert.2009.01.100.
- Hammoud A.O., Wilde N., Gibson M., Parks A., Carrell D.T., Meikle A.W. Male obesity and alteration in sperm parameters. Fertil. Steril. 2008; 90(6): 2222-5. https://dx.doi.org/10.1016/j.fertnstert.2007.
- Klenov V.E., Jungheim E.S. Obesity and reproductive function: a review of the evidence. Curr. Opin. Obstet. Gynecol. 2014; 26(6): 455-60. https://dx.doi.org/10.1097/GCO.0000000000000113.
- Bates G.W., Whitworth N.S. Effect of body weight reduction on plasma androgens in obese, infertile women. Fertil. Steril. 1982; 38(4): 406-9.
- Correa H., Jacoby J. Nutrition and fertility some iconoclastic results. Am. J. Chn. Nutr. 1978, 31(8): 1431-6.
- Громова О.А., Торшин И.Ю. Витамин D – смена парадигмы. М.: Торес Пресс; 2015. 464 с. [Gromova O.A., Torshin I.Yu. Vitamin D – a paradigm shift. Moscow: Torus Press; 2015. 464 p.(in Russian).]
- Chirayath H.H., Wareing M., Taggart M.J., Baker P.N. Endothelial dysfunction in myometrial arteries of women with gestational diabetes. Diabetes Res. Clin. Pract. 2010; 89(2): 134-40. https://dx.doi.org/10.1016/j.diabres.2010.03.022.
- Калинченко С.Ю., Ворслов Л.О., Тюзиков И.А., Тишова Ю.А. Влияние ожирения и инсулинорезистентности на репродуктивное здоровье женщин. Медицинский совет. 2015; 4: 82-7. [Kalinchenko S.Yu., Vorslov L.O., Tyuzikov I.A., Tishova Yu.A. The effect of obesity and insulin resistance on women’s reproductive health. Medical Advice/Meditsinskii sovet. 2015; (4): 82-7. (in Russian).] https://doi.org/10.21518/2079-701X-2015-4-82-87.
- Ткачук В.А., Воротников А.В. Молекулярные механизмы развития резистентности к инсулину. Сахарный диабет. 2014; 2: 29-40. [Tkachuk V.A., Vorotnikov A.V. Molecular mechanisms of insulin resistance. Sakharnyy diabet. 2014; (2): 29-40. (in Russian).] https://dx.doi.org/10.14341/DM2014229-40.
- Мельниченко Г.А., Романцова Т.И., Журавлева М.В. Всероссийская программа безопасного снижения веса «ПримаВера». Итоги первого года проведения. Ожирение и метаболизм. 2013; 4: 82. [Melnichenko G.A., Romantsova T.I., Zhuravleva M.V. All-Russian program of safe weight loss PrimaVera. The results of the first year. Obesity and Metabolism/Ozhirenie i metabolism. 2013; (4): 82. (in Russian).] https://dx.doi.org/10.14341/omet2014162-68.
- Федорова Е.П., Зароченцева Н.В., Полеско И.В., Малиновская В.В. Этиопатогенез самопроизвольного прерывания беременности: современные концепции. Вопросы гинекологии, акушерства и перинатологии. 2015; 14(2): 53-8. [Fedorova E.P., Zarochentseva N.V.,Polesko I.V., Malinovskaya V.V. Etiopathogenesis of spontaneous abortion: modern concepts. Gynecology, Obstetrics and Perinatology/Voprosy ginekologii, akusherstva i perinatologii. 2015; 14(2): 53-8.(in Russian).]
- Макарова Е.Л., Олина А.А. Витамин D3 –необходимый компонент на этапе прегравидарной подготовки. Фарматека. 2019; 26(6): 42-6. [Makarova E.L., Olina A.A. Vitamin D3 is an essential component in the pregravid preparation phase. Farmateka. 2019; 26(6): 42-6. (in Russian).] https://dx.doi.org/10.18565/pharmateca.2019.6.42-46.
- Hossein-nezhad A., Holick M.F. Vitamin D for health: a global perspective. Mayo Clin. Proc. 2013; 88(7): 720-55. https://dx.doi.org/10.1016/j.mayocp.2013.05.011.
- Громова О.А., Тетруашвили Н.К., Торшин И.Ю., Лиманова О.А. О новых тенденциях в нутрициальной поддержке при беременности. Акушерство и гинекология. 2018; 1: 21-8. [Gromova O.A., Tetruashvili N.K.,Torshin I.Yu., Limanova O.A. On new trends in nutritional support during pregnancy. Obstetrics and Gynecology/Akusherstvo i ginekologiya. 2018; (1): 21-8. (in Russian).] https://dx.doi.org/10.18565/aig.2018.1.21-28.
- Mayo Foundation for Medical Education and Research – Mayo Clin Proc. 2013;88(7):720–755.
- Громова О.А. Тетруашвили Н.К., Торшин И.Ю., Лиманова О.А. О новых тенденциях в нутрициальной поддержке при беременности. Акушерство и гинекология.2018;1:21–28. [Gromova O.A., Tetruashvili N.K., Torshin I.Yu., Limanova O.A. On new trends in nutritional support during pregnancy. Obstetrics and Gynecology.2018; 1:21–28]. https://dx.doi.org/10.18565/ aig.2018.1.21-28.
Received 19.03.2020
Accepted 31.03.2020
About the Authors
Elena L. Makarova, Cand. Med. Sci.; Obstetrician/Gynecologist, City Perinatal Center, M.A. Tverie City Hospital, Tел. +7(904)849-37-70.E-mail: makarova_803@mail.ru. ORCID-0000-0002-1330-8341; Scopus ID-278641.
2, Ignatyev Brothers St., Perm 614600, Russia
Anna A. Olina, MD; Professor, Deputy Director of Development, D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductology.
Tel.: +7(922)329-53-62. E-mail: olina29@mail.ru. ORCID 0000-0001-9101-7569; Scopus ID 56021173500.
3, Mendeleevskaya Line, Saint Petersburg 199034, Russia
Natalia A. Terekhina, MD; Professor, Head, Department of Biochemistry, Academician E.A. Vagner Perm State Medical University, Ministry of Health of Russia,
E-mail: terekhina@list.ru. ORCID 0000-0002-0168-3785, Scopus ID 7004162006.
28, Petropavlovskaya St., Perm 614990, Russia
For reference: Makarova E.L., Olina A.A., Terekhina N.A. Role of a comprehensive pregravid preparation program for obese women in the prevention of gestational complications.
Akusherstvo i Ginekologiya. 2020; 4: 182-188
https://dx.doi.org/10.18565/aig.2020.4.182-188
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