Метаболические расстройства и артериальная гипертензия в период беременности: ближайшие и отдаленные последствия для матери и плода

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.

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