Pathogenetic Significance of Insulin Resistance and Endothelial Dysfunction in the Development of Pregnancy Complications in Women with Obesity and Pre-eclampsia

Abstract

The purpose of the study was to analyze the effect of insulin resistance and endothelial dysfunction on the development of pregnancy complications in a group of obese women and women with pre-eclampsia. Materials and methods. To achieve this goal, we examined 393 pregnant women on the basis of the Poltava city clinical maternity hospital at the early (9-13 weeks) and later gestation (34-38 weeks). Pregnant women according to a degree of obesity and presence of pre-eclampsia were devided into three groups: the first group – 149 pregnant women with obesity of the first degree, the second group – 73 pregnant women with obesity of the second degree, the third group – 46 pregnant women with obesity of the third degree, the fourth group – 6 pregnant women with physiological body weight and pre-eclampsia, the fifth group – 6 pregnant women with obesity of the first degree and pre-eclampsia, the sixth group – 6 pregnant women with obesity of 2nd-3rd degrees and pre-eclampsia. The index of insulin resistance HOMA-IR, the level of expression of CD32+CD40+ of circulating endothelial microparticles, which was determined by flow cytophluorimetry, were determined in pregnant women. In women of experimental and control groups the frequency of complications of pregnancy was compared. Results and discussion. In pregnant women with obesity as a result of increased insulin resistance and reducing glucose absorption by tissues there are preconditions for the development of energy insufficiency, as well as an increase in the amount of CD32+CD40+ of circulating endothelial microparticles in the peripheral blood in pregnant women, who had pre-eclampsia, which joined. It confirms the existence of endothelial dysfunction. The deterioration of these indicators progressed as the severity of obesity increases. Comparisons of the frequency of pregnancy complications in experimental and control groups of women indicate that obesity is a risk factor for the emergence of these complications of pregnancy. Conclusion. Thus, the progression of insulin resistance during pregnancy in a group of women with obesity of varying degrees and induced endothelial dysfunction is a pathogenic basis for energy insufficiency and reduction of adaptive mechanisms of pregnant women with obesity, as convincingly indicates an increase in the frequency of obstetric and perinatal complications