PECULIARITIES OF LIPID EXCHANGE IN PREGNANT WOMEN WITH OBESITY.

The high frequency of obstetric pathology is explained by the violation of adaptive and compensatory-protective mechanisms, the breakdown of the activity of regulatory systems that occur during obesity. Determining the levels and dynamics of changes in lipid metabolism during the gestation period in pregnant women with obesity is of particular interest. The purpose of this study was to evaluate the dynamics of lipid metabolism changes in pregnant women with obesity. The work is based on clinical-anthropometric and clinical-laboratory results of studies of 52 pregnant women with abdominal obesity (the main group). The term of pregnancy was determined by anamnestic data (date of last menstruation, first appearance in a women's consultation) and the results of ultrasound fetometry. The criteria for inclusion of patients in the main group were a BMI value above 25 kg/m2. Waist circumference (FROM) and hip circumference (ABOUT) were also measured. The ratio FROM/TO was calculated. Obesity was regarded as abdominal with a waist circumference of more than 80 cm and an OT/OB ratio of ≥0.85.The control group consisted of 80 healthy pregnant women with a BMI before pregnancy of 18.5-25 kg/m2. The values of the studied indicators obtained in this group were used as a starting point of comparison as physiologically normal values. The state of fat metabolism was assessed according to lipidogram data. The study was conducted three times during pregnancy - at 8-12, 18-20 and 34-36 weeks of gestation. Blood samples were taken from the ulnar vein in the morning on an empty stomach 12-14 hours after eating. High- and low-density lipoproteins were determined by the homogeneous method, total cholesterol and triglycerides were determined by the enzymatic colorimetric method. It was found that the increasing imbalance of lipidogram parameters was accompanied by an increase in BMI: OH (r=0.251; p=0.001), TG (r=0.401; p=0.002), VLDL (r=0.365; p=0.033), HDL (r=-0.318; p=0.002). The development of pregnancy was accompanied by an increase in fat metabolism in the main group at 18-20 and 34-36 weeks of gestation, respectively: OH - by 16.5% and 22.1%, LDL - by 6.3% and 13.0%, TG - by 13.6% and 28.4%, VLDL - by 14.3% and 28.5%. We have revealed the inverse dependence of HDL levels on the duration of pregnancy. So, if the HDL level at the gestation periods of 8-12 and 18-20 weeks did not have a significant difference (p>0.05) with the level of the control group, then by the end of gestation its significant decrease was observed. A decrease in HDL values - by 3.3% and 17.6% during gestation led to a pronounced increase in the atherogenicity coefficient by 32.1% and 76.4% during pregnancy at 18-20 weeks and 34-36 weeks, respectively. This coefficient indicates the distribution of OH between HDL and atherogenic lipoprotein fractions. Anti-atherogenic ratio of HDL/LDL decreased slightly in the dynamics of pregnancy in obese women - by 7.5% and 27.2%, respectively. Thus, the results of the study indicate a significant increase in the group of obese pregnant women in the content of total cholesterol, triglycerides, VLDL with their maximum level by the end of gestation in comparison with patients with normal body weight. Despite the fact that the metabolic changes occurring in the body of a pregnant woman are adaptive, they can play a role in the pathophysiological process of the development of pregnancy complications and labor disorders. With the progression of pregnancy, abdominal obesity in women is a risk factor for the development of pathological dyslipidemia.