FUNCTIONAL STATE OF FETOPLACENTAL COMPLEX IN PREGNANT WOMEN WITH OBESITY AND METABOLIC SYNDROME
The objective of the study is to examine the characteristics of functional state of fetoplacental complex according to the type of obesity and development of metabolic syndrome. Materials and Methods. The state of the fetoplacental complex was studied in 229 women, including 46 women with neuroendocrine obesity (NEO), 41 women with the alimentary-constitutional obesity (ACO), and 20 non-obese women. Besides, metabolic syndrome (MS) was observed in 85 women, and 37 women did not demonstrate it. HDJ-3000 and Aloka SSD-650 ultrasound scanner were used for ultrasonic feto- and placentometry, and Doppler assessment of uterine vessels and umbilical cord. Morphological study of the placenta was carried out according to A.P. Milovanov and A.I. Brusilovsky method (E.P. Kalashnikova's variant). Percentile evaluation of ultrasound biometry was used to assess fetus growth and development. Results. In pregnant women with obesity, the systolic-diastolic ratio (SDO) in the umbilical cord artery increases by 17.3 % since the 28th week of pregnancy, and by 33.8 % since the 36th week. This fact indicates a risk of antenatal fetal damage. Placentas of women with NEO have morphological signs of placental hormone activation in 53.3 % of cases, taking form of pathological villous immaturity, while 67.9 % of women with ACO demonstrate suppression of placental hormone synthesis, combined with hypamnion (57.1 %). Under metabolic syndrome, SDO values in the uterine arteries exceed the norm in 75.3 %, in the umbilical cord arteries in 57.7 %, and in the fetal aorta in 62.4 % as compared with women without metabolic syndrome. Conclusion. Every second woman with NEO demonstrates reduced blood flow in the fetus umbilical cord, and abnormalities in villi formation. These disorders indicate the development of secondary placental insufficiency. Women with ACO demonstrate destructive changes, placental ischemia, sclerosis and fibrosis of the stroma. These are the symptoms of primary decompensated placental insufficiency. At early pregnancy women with a metabolic syndrome have marked rheological defects in the intervillian space and angiomatous changes in villi, when acroteric villi do not take part in placental exchange.