Since leptin is always associated with overweight, pregnancy is well within its sphere of influence. Body weight during pregnancy increases due to fat deposits in the subcutaneous fatty tissue, internal organs and tissues, and this certainly affects the course of pregnancy. It is manifested by active synthesis of leptin fat cells obesity, fatty folds, poor tolerance of physical activity, angularity, hypodynamia, shortness of breath. Obesity in pregnancy is diagnosed on the basis of BMI, which is compared to the normal values recorded in the table and used to control weight gain. You will learn about how extra pounds are corrected and gestational complications are treated in this article.
- General information.
- Development mechanism.
- Methods of correction.
- Prognosis and prevention.
Excessive weight is the result of a disorder of lipid metabolism. This is the scourge of modern mankind. Obesity affects about one third of women of reproductive age, and the number of cases is increasing progressively from year to year. Specialists believe that the problem is urgent due to the risk of complications during gestation and the increase in perinatal mortality, which, according to various sources, ranges from 3 to 10%.
A key trigger for obesity before gestation and during pregnancy is an energy imbalance affiliated with leptin. If the intake of food provokes the accumulation of excess energy in the body, exceeding its expenditure, obesity occurs. In 95% of cases, this situation is caused by poor eating habits, high caloric intake and hypodynamia. Heredity also plays a significant role.
In 5% of cases, the disease develops against the background of endocrine and metabolic disorders:
- Enzyme mutations in genes that control lipid metabolism, brain disorders, adrenal and ovarian pathology, hypothyroidism. With pregnancy comes a number of additional causes that potentiate the accumulation of fat.
- Hormonal restructuring. In order to maintain pregnancy and the activity of anabolic processes in a woman’s body, the synthesis of estrogen, progesterone, prolactin, which stimulate lipogenesis, increases. Obesity is increased by decreasing the sensitivity of tissues to insulin and leptin, the hormone of adipose tissue, by increasing their levels in the bloodstream, by the hyperproduction of another peptide hormone – ghrelin, which stimulates appetite.
- Minimization of motor activity. Additional strain, which a pregnant woman is forced to experience, causes high fatigue and malaise. The situation is aggravated by anemia, gestosis, exacerbation of chronic infections, and extragenital pathologies. Pregnant women perceive gestation as a pathological condition, become less mobile and expend a minimum of energy.
Significant weight gain during pregnancy can be provoked by an increase in circulating blood volume, formation of the placenta and fetal membranes, growth of the fetus itself, abundant fluid retention in the body. But just in these processes leptin is not involved, because they are not accompanied by activation of lipogenesis. The development of true weight gain in gestation is due to a slowdown of the main metabolism, which is associated with the work of the thyroid gland and the development of insulin and leptin resistance.
Mechanism of development
The leading trigger in the development of obesity is increased lipogenesis with deposition of excess fat in lipid layers. There is an imbalance in the fat cells that are full of energy, provoked by overeating and hypodynamia. Excessive caloric intake stimulates the hypothalamus and the synthesis of leptin, which controls appetite. Inflammation or trauma to the brain leads to this condition much less frequently. Increased appetite is also associated with physiological hypersecretion of ghrelin, a leptin antagonist. Its maximum is fixed by the middle of the 2nd trimester.
Conditions occur during pregnancy that contribute to an increase in the hypodermis. Its role is to stabilize the energy potential, which should be sufficient for the normal development of the child and then for its feeding. Hormonal changes, which concern directly and leptin synthesis, stimulate the accumulation of fat and block its expenditure from fat depots. Estrogens, the concentration of which increases hundreds of times during pregnancy, activate lipoprotein lipase, an enzyme that helps fat to spread to the thighs and buttocks. In parallel, lipolysis is blocked as a result of increased levels of progesterone in contact with leptin receptors in fat cells and glucocorticosteroid receptors.
The systematization of different forms of obesity is based on the triggers of pathology, the nature of eating habits, metabolic disorders, localization of fat, and BMI. Obesity in pregnancy is usually primary, it is formed on the basis of alimentary and constitutional deviations from the norm, much less often the genesis is secondary or symptomatic. Fat deposits are most often distributed in the lower or gynoid type, only in a small proportion of patients – in the upper or android type, even more rarely – mixed. In predicting the outcome of pregnancy should be guided by the degree of obesity, which is determined by taking into account the deviation of a woman’s weight before conception from the norm. The calculation goes by the formula: height in cm – 100.
It turns out:
- Pre-fatting, when in increases in proportion to the norm and not more than 10%. The risk of gestational complications is slightly increased.
- Grade I, when “overweight” is no more than a third of the norm. In this case, complications occur in a quarter of women.
- Grade II, when the excess weight does not exceed 50%. Complications occur in 80% of patients.
- Grade III, when the weight is increased by almost 100%. Such gestation complications also occur in almost 100%.
- Grade IV, when the weight gain is over 100%, and gestation in this case is a rarity, and if it occurs, it always flows with complications.
The severity of the signs of obesity correlates with the degree of fat accumulation. In the initial stages, when obesity does not exceed 50%, women are bothered by fatigue, rapid fatigue, shortness of breath, hyperhidrosis, constipation. Visually noticeable deposits of extra pounds in the thighs, buttocks, abdomen, chest, shoulder girdle, back, neck, and chin. And the breasts increase in size due to fatty tissue. With obesity above the third degree, excess fatty tissue forms folds, shortness of breath appears not after exercise but at rest, movement is restricted, and there is persistent pastosity of the tissues. The spine and large joints are often disturbed.
Leptin addiction is manifested by uncontrollable appetite, which is the result of disruption of direct communication of the adipose tissue hormone receptors with the brain.
During pregnancy, excessive weight is directly related to the development of gestational complications. Both obstetric and somatic pathologies occur. According to different authors, pregnancy complications range from 45% to 85% in women with obesity and any degree of obesity. Half of pregnant women with excessive weight have gestosis, the rate of which increases threefold in the most severe types of pregnancy: hypertension, eclampsia, preeclampsia. After delivery, such patients have a sevenfold increased risk of cardiovascular abnormalities. Pregnant women with a BMI (body mass index) greater than 30.0 in more than half of cases give birth to children with anencephaly and 40% more often with spina bifida. The risk of such anomalies in the fetus is two or more times higher in android obese pregnant women.
The frequency of spontaneous miscarriages and pregnancy failure reaches almost 40%, fetoplacental insufficiency is also diagnosed in almost 40% of cases, fetal hypoxia – in a quarter of cases and more, newborn weight deficiency – in 20%, macrosomia – 45%. An increase in body weight by 3 units leads to a risk of antenatal death by over 60%. Premature and late labor is possible in 10% of cases. More than half of women in labor show weakness of labor forces, and one third of women have discoordinated contractions of the myometrium. Coagulopathies and bleeding are highly probable. Birth trauma rate is almost 50%. Caesarean section and other surgical interventions in obese women are performed 4 times more often, and postpartum endometritis develops in 5%.
In half of the cases, additional diagnoses are:
- infections due to reduced immunity;
- cardiovascular abnormalities associated with leptin and its control of energy expenditure;
- lesions of the respiratory system;
- urological problems;
- diseases of the digestive tube;
- gestational diabetes, affiliated with leptin and capable of transformation after delivery into type 2 diabetes mellitus.
The purpose of diagnosis in the presence of obesity is to assess the degree of pathology, identify the triggers that cause it and the risk of complications.
The examination is complex and includes:
- physical examination;
- laboratory methods;
- instrumental examination.
To establish obesity and determine the degree of its severity, compare the real weight with the optimal weight using:
- BMI calculation. Excess kilograms are counted using the formula for the ratio of body weight in kilograms to height in meters squared. If the result is about 30 units – this is an elevated index, up to 35 – high, up to 40 – very high, more than 40 – excessive.
- Control of weight gain. Increased weight gain indicates the risk of developing obesity or transition of one degree to another. By the end of gestation the total weight gain is normal no more than 16 pounds. If diagnosed as pre-fat, you can gain no more than 11 kg, with obesity – no more than 9 kg.
When assessing markers of obesity, which include leptin, the pregnant woman’s belonging to women of small stature, adolescence, and multiple gestation is taken into account. Measurement of waist circumference, hip circumference during gestation are not informative due to the fact that these indicators are distorted due to uterine growth. The examination algorithm includes blood pressure monitoring, blood chemistry – glucose tolerance, markers of lipid metabolism, protein metabolism, liver function tests. In addition, general urine analysis, ECG, EchoCG, ultrasound examination of the liver and pancreas are mandatory. If necessary, consultations of narrow specialists are carried out.
Methods of correction
The aim of correction of obesity is to restore the energy balance, that is, balancing the synthesis of the hormones leptin and ghrelin on the background of a rational eating behavior to prevent possible complications. Neither medication nor surgery is allowed during pregnancy. Hunger – excluded because of the formation of ketones, toxic to the fetus. What remains to be done?
To minimize excess weight it is recommended:
- A balanced diet, where the optimal solution is the individual formulation of the daily diet by a nutritionist. Blocking the intake of excessive calories is carried out under the control of weight gain and concerns the minimization of consumed fats, simple carbohydrates, limiting salt, spices and supplementing the diet with proteins, vegetables, fruits, vitamins and minerals. In order not to freeze the basic metabolism, the daily volume of food consumed is divided into 4-5 portions.
- Movement activation, when to increase the energy expenditure of the body is recommended exercise in the morning, a walk at night, lasting at least half an hour, LFC classes in the group at the perinatal centers. Taking into account the duration of pregnancy and its severity, an LFC doctor may recommend yoga, aqua aerobics, breathing exercises that speed up the basic metabolism, such as bodyflex or oxycise.
If complications develop and obesity is a trigger, adequate therapy is prescribed. For pre-fatty or grade 1 obesity without any special obstetric indications for a cesarean section, natural childbirth is practiced. For stage II-III obesity, the patient is hospitalized a couple of weeks before the expected delivery date. The doctor decides on the method of delivery based on the results of the examination.
Prognosis and prevention
The outcome of pregnancy and delivery correlate with the severity of the pathology. The most dangerous prognosis is grade 3 obesity (grade 4 births are exceptionally rare). Women with excessive weight are advised to pay attention to weight correction when planning pregnancy. To do this it is worth using a leptin diet, if there are no individual contraindications to it. Do not make such decisions on your own – it is the prerogative of your doctor.
The purpose of prevention is the prevention of complications. It involves timely registration in the antenatal clinic, regular examinations by the doctor conducting the pregnancy, laboratory and instrumental screening, control of weight gain.