The design of the study involved the clinical, laboratory, enzyme-linked immunosorbent assays, instrumental methods, conducting a questionnaire of women, standard methods of variational statistics. 189 women and their newborns were enrolled. The first group consisted of 68 overweight women (body mass index 25.0-29.9 kg/m2), who received generally accepted prepregnancy care and routine antenatal care, the second group consisted of 49 patients with the recommended body weight (body mass index 18.5-24.9 kg/m2), 72 overweight women (comparison group), who were proposed treatment and prevention program at the preconceptional stage and during pregnancy.
It was analyzed that 82.8 % of the survey participants associated excessive body weight with a high/very high risk of obstetric complications, with the least awareness of the gestational diabetes risk developing (67.6 %). However, it was demonstrated the high chances of underestimating a high risk of operative delivery (3.80; 1.83-7.87), preterm delivery (2.96; 1.47-5.95), adverse neonatal outcomes (2.96; 1 .47-5.95) and especially risk of congenital birth defects (5.50; 2.62-11.54) in overweight patients. An underestimation of the risk of developing negative pregnancy outcomes after weight loss before conception has been confirmed. The main barriers to weight optimizing before pregnancy were insufficient basic knowledge about the risk of maternal, especially perinatal complications during pregnancy and labor associated with excessive body weight, family culture and habits, unsuccessful repeated unsystematic attempts to lose weight, lack of information and insufficient counseling of medical providers on this issue.
In the research it was shown, that in the group of overweight women, the average degree of eating behavior was 1.7 times lower compared to the group with a normal body mass index (respectively, 5.01±1.23 vs. 8.29±1.05 points). Excessive body weight was associated with a low level of eating behavior (5.80; 2.04-16.47), while a high degree increased the odds of normal body weight (5.60; 2.50-12.53). During pregnancy, there was a deterioration in eating behavior and diet, which was manifested in an increase in the chances of excessive weight gain ((3.13; 1.15-8.43) and (5.00; 1.45-17.27), respectively, in women with high and normal body mass index). It is shown that less than half of overweight patients (48.5 %) followed the recommended moderate level of physical activity compared to 71.4 % with normal body weight, as well as the frequency of women with low and sedentary activity in 3.0 and 3.9 times were greater compared to the group with a normal body mass index. During pregnancy, overweight women were diagnosed with significantly higher percentages of low level of physical activity by 2.1 times and sedentary activity by 5.1 times, as well as a higher rate of low intensity (94.47±9.33 vs. 53.80± 9.25 MET-h/week) compared to normal weight pregnant women.
It was established that excessive body weight was characterized by significantly higher levels of pro-inflammatory cytokines on the preconceptional stage, and elevation during pregnancy at all levels of gestational weight gain. The strong relationships between the increase in body fat percentage and tumor necrosis factor-α (r=0.87, p<0.001), interleukin-1b (r=0.84, p<0.001), interleukin-6 (r =0.87, p<0.001) and C-reactive protein (r=0.87, p<0.001) in the third trimester of pregnancy were found.
It has been statistically proven that both initial excessive body weight and excessive gestational weight gain were associated with an increased risk of gestational hypertension ((2.99; 1.10-8.12) and (6.71; 2.14-21.03)), preeclampsia ((4.17; 1.55-11.17) and (6.71; 2.14-21.03)), gestational diabetes ((9.26; 1.15-74.36) and (11.21; 1.40-89.97)) respectively. During overweight pregnant were diagnosed a significant increase of labor complications: anomalies of labor activity by 4.6 times, induced labor by 3.3 times, fetal distress by 7.3 times, birth traumatism of the mother by 1.7 times, obstetric bleeding 3.0 times, abdominal delivery 3.2 times compared to the group with a normal body mass index. It is shown that the risk of macrosomia increases both with initial excess body weight and excessive weight gain during pregnancy ((5.55; 1.19-25.88) and (6.76; 1.45-31.48) respectively) in a proven association with metabolic, hormonal, immunological and endothelial disorders, starting from the preconceptional period and deepening during pregnancy.
Key words: overweight, preconceptional care, insulin resistance, gestational weight gain, physical activity, pregnancy, carbohydrate-lipid metabolism, insufficiency and deficiency of vitamin D, markers of chronic systemic inflammation, endothelial dysfunction, obstetric and perinatal complications, gestational diabetes, gestational hypertension, preeclampsia, treatment and prevention complex. Branch-Medicine.
