cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-1798Research ArticleОБЗОРЫREVIEWSМетаболические расстройства и артериальная гипертензия в период беременности: ближайшие и отдаленные последствия для матери и плодаMetabolic disturbances and arterial hypertension in pregnancy: short- and long-term effects on mother and fetusТкачеваО. Н.TkachevaO. N.tkacheva@rambler.ruПолятыкинаТ. С.PolyatykinaT. S.МишинаИ. Е.MishinaI. E.БарабашкинаА. В.BarabashkinaA. V.Московский государственный медико-стоматологический университет. МоскваMoscow State Medico4Stomatological University. MoscowИвановская государственная медицинская академия Росздрава. ИвановоIvanovo State Medical Academy, State Federal Agency for Health and Social Development. IvanovoВладимирская областная клиническая больница. ВладимирVladimir Regional Clinical Hospital. Vladimir20060101197058101108Copyright © Ткачева О.Н., Полятыкина Т.С., Мишина И.Е., Барабашкина А.В., 19701970Ткачева О.Н., Полятыкина Т.С., Мишина И.Е., Барабашкина А.В.Tkacheva o.N., Polyatykina T.S., Mishina I.E., Barabashkina A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1798

Эпидемиологические исследования подтвердили гипотезу о том, что риск развития метаболического синдрома (МС), артериальной гипертензии (АГ), ишемической болезни сердца формируется до рождения. Гестационный диабет (ГД) и ожирение - метаболические расстройства, встречающиеся во время беременности. Развитие инсулинорезистентности (ИР) приводит в ранние сроки гестации к разрастанию жировой ткани и повышению фетоплацентарной питательной ценности в поздние сроки беременности, когда происходит 70% нарастания веса плода. Увеличение ИР матери имеет репродуктивное преимущество в случае недостаточного питания и интенсивной работы женщины, но может повлечь за собой развитие ГД на фоне гиперкалорийной диеты и низкой физической активности. Повышение ИР в сочетании с ожирением перед зачатием, увеличивает риск макросомии и избыточного веса плода. Крупные дети, родившиеся у женщин с ГД, имеют повышенный риск развития юношеского ожирения и сахарного диабета (СД) 2 типа. Уменьшение роста и размеров плода во время беременности и в ранний постнатальный период также приводят в последующем к развитию СД и МС. Несмотря на то, что молодые женщины имеют низкий уровень сердечно-сосудистой заболеваемости, гестационная гипергликемия в комбинации с ожирением до беременности и гипертензивный синдром в период гестации многократно увеличивают кардиоваскулярный риск. Женщины с диагностированными в период беременности метаболическими расстройствами и АГ, а также рождающиеся дети требуют пристального наблюдения и, возможно, медицинского вмешательства.

Fpidemiology studies have confirmed a hypothesis on pre-natal risk determination for metabolic syndrome (MS), arterial hypertension (AH), and coronary heart disease (CHD). Gestational diabetes (GD) and obesity are typical metabolic disturbances in pregnancy. Insulin resistance (IR) development at early gestation stages results in fat tissue proliferation and increased feto-placental nutritious value by late pregnancy stages, when fetus weight increases by 70%. Increased IR in mother provides reproductive benefit in case of under-nutrition and over-working, at the same time being able to result in GD, when combined with calorie-rich diet and sedentary lifestyle. Increased IR and pre-conception obesity increase macrosomia and fetus overweight risk. Overweight children of GD mothers have increased risk of juvenile obesity and type 2 diabetes mellitus (DM-2). Decreased fetal height and body size in pregnancy and early post-natal period could also result in DM and MS later in life. In spite of low cardiovascular morbidity in young women, gestational hyperglycemia combined with pre-pregnancy obesity, as well as gestational hypertensive syndrome, significantly increase cardiovascular risk. Women with pregnancy-diagnosed metabolic disturbances and AH, as well as their children, need to be actively followed-up and treated, if necessary.

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The authors declare that there are no conflicts of interest present.