Preview

Кардиоваскулярная терапия и профилактика

Расширенный поиск

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

Полный текст:

Аннотация

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.

Об авторах

О. Н. Ткачева
Московский государственный медико-стоматологический университет. Москва
Россия


Т. С. Полятыкина
Ивановская государственная медицинская академия Росздрава. Иваново
Россия


И. Е. Мишина
Ивановская государственная медицинская академия Росздрава. Иваново
Россия


А. В. Барабашкина
Владимирская областная клиническая больница. Владимир
Россия


Список литературы

1. Чазова И.Е., Мычка В.Б. Метаболический синдром. Москва «Медиа Медика» 2004; 168 с.

2. Despres J.P., Lamarche В., Mauriege Р., et al. Hyperinsulinemia as an independent risk factor for ischemic lieart disease. N Engl J Med 1996; 334(15): 952-7.

3. Richard P.D., Trevor J.O. Hyperinsulinemia and resistance: associations with cardiovasculars and disease. Cardiovasc rise factors 1993; 1: 12-8.

4. Lembo G., Rendina V. Acute noradrenergic activation induces insulin resistence in human skeletal muscle. Am J Physiol 1994; 266: E242-7.

5. Hone J., Accili D., Al-Gazali L.I., et al. Homozygosity for a new mutation (ILe -Met) in the insulin receptor gene in five sibs with familial insulin resistance. J Med Genet 1994; 31: 715-6.

6. Haffner S.M., Stern M.P., Hazuda H.P., et al. Increased insulin concentration in nondiabetic offspring of diabetic parents. N Engl J Med 1988; 319: 1297-301.

7. Gluckman P.D., Hanson M.A. The developmental origins of the metabolic syndrome. Trends Endocrinol Metab 2004; 15(4): 183-7.

8. Williams D. Pregnancy: a stress test for life. Curr Opin Obstet Gynecol 2003; 15(6): 465-71.

9. Coustan D.R. Gestational diabetes. In: Diabetes in America (Harris M. I., Cowie C.C., Stern M.P., Boyko E.J., Reiber G., Bennett PH., eds.). 2nd Edition Publication 1995; 703-17.

10. Betscher N.A., Wein P., Sheedy M.T., Steffer B. Identification and treatment of women with hyperglycemia diagnosed during pregnancy can significantly reduce perinatal mortality rates. N Z J Obstet Gynecol 1996; 36: 239-47.

11. Silverman B.L., Rizzo Т.А., Cho N.H., Metzger B.E. Long-term effects of the intrauterine environment. Diabetes 1998; 21(Suppl. 2): 142-9.

12. Pettitt D.J., Nelson R.G., Saad M.F., et al. Diabetes and obesity in the offspring of Pima Indian women with diabetes during pregnancy. Diabetes Care 1993; 16: 310-4.

13. Metzger B.E., Coustan D.R. Summary and recommendations of the Fourth International Workshop Conference on Gestational Diabetes Mellitus. Diabetes Care 1998; 21(Suppl. 2): B161-7.

14. Catalano P.M., Kirwan J.P., Mouzon S.H., King J. Gestational Diabetes and Insulin Resistance: Role in Short-and Long-Term Implications for Mother and Fetus. J Nutr 2003; 133: 1674S-83.

15. Xiang A.H., Peters R.H., Trigo E., et al. Multiple metabolic defects during late pregnancy in women at high risk for type 2 Diabetes. Diabetes 1999; 48: 848-54.

16. Catalano P.M., Huston L., Amini S.B., Kalhan S.C. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes. Am J Obstet Gynecol 1999; 180: 903-16.

17. Catalano P.M., Tyzbir E.D., Wolfe R.R., et al. Carbohydrate metabolism during pregnancy in control subjects and women with gestational diabetes. Am J Physiol 1993; 264: E60-70.

18. Catalano P.M., Bernstein I.M., Wolfe R.R, et al. Subclinical abnormalities of glucose metabolism in subjects with previous gestational diabetes. Am J Obstet Gynecol 1986; 155: 1255-63.

19. Duggleby S.L., Jackson A.A. Protein, amino acid and nitrogen metabolism during pregnancy: How might the mother meet the needs of her fetus? Curr Opin Clin Nutr Metab 2002; 5(5): 503-9.

20. Kalhan S.C., Rossi K.Q., Gruca L.L., et al. Relation between transamination of branched-chair amino acids and urea synthesis: Evidence from human pregnancy. Am J Physiol 1998; 275: E423-31.

21. Duggleby S.C., Jackson A.A. Relationship of maternal protein turnover and lean body mass during pregnancy and birth weight. Clin Sci 2001; 101:65-72.

22. Darmady J.M., Postle A.D. Lipid metabolism in Pregnancy. BJOG 1982;89:211-5.

23. Knopp R.H., Bergelin R.O., Wahl P.W., Walden C.E. Relationships of infant birth size to maternal lipoproteins, apoproteins, fuels, hormones, clinical chemistries, and body weight at 36 weeks gestation. Diabetes 1985; 34(Suppl. 2): 71-7.

24. Ogburn P.L., Goldstein M., Walker J., Stonestreet B.S. Prolonged hyperinsulinemia reduces plasma fatty acid levels in the major lipid groups in fetal sheep. Am J Obstet Gynecol 1989; 161: 728-32.

25. Kliegman R., Gross T., Morton S., Dunnington R. Intrauterine growth and postnatal fasting metabolism in infants of obese mothers. J Pediatr 1984; 104: 601-7.

26. Knopp R.H., Chapman M., Bergelin R.O., et al. Relationship of lipoprotein lipids to mild fasting hyperglycemia and diabetes in pregnancy. Diabetes Care 1980; 3: 416-20.

27. Catalano P.M., Nizielski S.E., Shao J., et al. Down regulation of IRS-1 and PPARgamma in obese women with gestational diabetes: Relationship to free fatty acids during pregnancy. Am J Perinatal 2002; 282: E522-33.

28. Eastman N.J., Jackson E. Weight relationships in pregnancy. Obstet Gynecol Surv 1968; 23: 1003-25.

29. Humphreys R.C. An analysis of the maternal and fetal weight factors in normal pregnancy. J Obstet Gynaecol Br Emp 1954; 61: 764-71.

30. Abrams B.F., Laros R.K. Prepregnancy weight, weight gain, and birth weight. Am J Obstet Gynecol 1986; 154: 503-9.

31. Kliegman R., Gross T., Morton S., Dunnington R. Intrauterine growth and postnatal fasting metabolism in infants of obese mothers. J Pediatr 1984; 104: 601-7.

32. Bo S., Menato G., Gallo M.L., et al. Mild gestational hyperglycemia, the metabolic syndrome and adverse neonatal outcomes. Acta Obstet Gynecol Scand 2004; 83(4): 335-40.

33. Catalano P.M., Thomas A., Drago N.M., Amini S.B. Body composition and fat distribution in infants of women with normal and abnormal glucose tolerance. Am J Obstet Gynecol 1994; 170: 302.

34. Mokdad A.H., Ford E.S., Bowman B.A., et al. Diabetes trends in the U.S. 1990-1998. Diabetes Care 2000; 23: 1278-83.

35. American Diabetes Association. Consensus statement: type 2 diabetes in children and adolescents. Diabetes Care 2000; 23: 381-99.

36. Sinha R., Fisch G., Teague B., et al. Prevalence of impaired glucose tolerance among children and adolescents with morbid obesity. N Engl J Med 2002; 346: 802-10.

37. Silverman B.L., Rizzo Т.А., Cho N.H., Metzger B.E. Long-term effects of the intrauterine environment. Diabetes 1998; 21(Suppl. 2): 142-9.

38. Pettitt D.J., Nelson R.G., Saad M.F., et al. Diabetes and obesity in the offspring of Pima Indian women with diabetes during pregnancy. Diabetes Care 1993; 16: 310-14.

39. Bjornholt J.V., Erikssen G., Liestol K., et al. Type 2 diabetes and maternal family history. Diabetes Care 2000; 23: 1255-9.

40. Caruso A., Paradisi G., Ferrazzani S., et al. Effect of maternal carbohydrate metabolism in fetal growth. Obstet Gynecol 1998; 92: 8-12.

41. Ozanne S.E., Hales C.N. Early programming of glucose-insulin metabolism. Trends Endocrinol Metab 2002; 13(9): 368-73.

42. Hales C.N., Ozanne S.E. For debate: Fetal and early postnatal growth restriction lead to diabetes, the metabolic syndrome and renal failure. Diabetologia 2003; 46(7): 1013-9.

43. Bertram C.E., Hanson M.A. Prenatal programming of postnatal endocrine responses by glucocorticoids. Reproduction 2002; 124(4): 459-67.

44. Hales C.N., Barker D.J., Clark P.M., et al. Fetal and infant growth and impaired glucose tolerance at age 64. BMJ 1991; 303: 1019-22.

45. Ong K.K., Dunger D.B. Birth weight, infant growth and insulin resistance. Eur J Endocrinol 2004; 151(Suppl 3): U131-9.

46. O'Sullivan J.B. Body weight and subsequent diabetes mellitus. JAMA 1982; 248: 949-52.

47. Verma A., Boney C.M., Tucker R., Vohr B.R. Insulin resistance syndrome in women with prior history of gestational diabetes

48. Bo S., Monge L., Macchetta C., et al. Prior gestational hyperglycemia: a long-term predictor of the metabolic syndrome. J Endocrinol Invest 2004; 27(7): 629-35.

49. Stein Z., Susser M. The Dutch famine, 1944-45, and the reproductive process. I. Effects on six indices at birth. Pediatr Res 1975; 9: 70-6.

50. Ravelli A.C.J., van der Meulen J.H.P., Bleker O.P., et al. Body size of newborn babies after prenatal exposure to the Dutch famine of 1944-45. In: Prenatal exposure to the Dutch famine and glucose

51. Ravelli A.C.J., van der Meulen J.H.P., Osmond C., et al. Obesity after prenatal exposure to famine in men and women at the age of 50. In: Prenatal exposure to the Dutch Famine and glucose tolerance and obesity at age 50. University of Amsterdam 1999; 5: 75-87.

52. Kjos S.L., Buchanan Т.А., Greenspoon J.S., et al. Gestational diabetes mellitus: The prevalence of glucose intolerance and diabetes mellitus in the first tow months post partum. Am J Obstet Gynecol 1990; 163: 93-8.

53. Metzger B.E., Cho N.H., Roston S.M., Radvany R. Prepregnancy weight and insulin secretion predict glucose tolerance five years after gestational diabetes mellitus. Diabetes Care 1993; 16: 1598-1605.

54. Tenhola S., Rahiala E., Martikainen A., et al. Blood pressure, serum lipids, fasting insulin, and adrenal hormones in 12-year-old children born with maternal preeclampsia. J Clin Endocrinol Metab 2003; 88(3): 1217-22.

55. Pouta A., Hartikainen A.L., Sovio U., et al. Manifestations of metabolic syndrome after hypertensive pregnancy. Hypertension 2004; 43(4): 825-31.

56. Rodie V.A., Freeman D.J., Sattar N., Greer L.A. Preeclampsia and cardiovascular disease: metabolic syndrome of pregnancy? Atherosclerosis 2004; 175(2): 189-202.

57. Havivi E., On H.B., Reshef A., et al. Vitamins and trace metals status in non insulin dependent diabetes mellitus. Int J Vitam Nutr Res 1991; 61: 328-33.

58. Tang X., Shay N.F. Zinc has an insulin-like effect on glucose transport mediated by phosphoinositol-3-kinase and Akt in 3T3-L1 fibroblasts and adipocytes. J Nutr 2001; 131: 1414-20.

59. Canfield W.K., Hambidge K.M., Johnson L.K. Zinc nutriture in type I diabetes mellitus: relationship to growth measures and metabolic control. J Pediatr Gastroenterol Nutr 1984; 3: 577-84.

60. Heise C.C., King J.C., Costa F.M., Kitzmiller J.L. Hyperzincuria in IDDM women. Relationship to measures of glycemic control, renal function, and tissue catabolism. Diabetes Care 1988; 11:780-6.

61. McNair P., Kiilerich S., Christiansen C., et al. Hyperzincuria in insulin treated diabetes mellitus-its relation to glucose homeostasis and insulin administration. Clin Chim Acta 1981; 112: 343-8.

62. Wibell L., Gebre-Medhin M., Lindmark G. Magnesium and zinc in diabetic pregnancy. Acta Paediatr Scand 1985; 320: 100-6.

63. Smith R.G., Heise C.C., King J.C., et al. Serum and urinary magnesium, calcium and copper levels in insulin-dependent diabetic women. J Trace Elem Electrolytes Health Dis 1988; 2: 239-43.

64. Sjogren A., Floren C-H., Nillsson A. Magnesium deficiency in IDDM related to level of glycosylated hemoglobin. Diabetes 1986;35:459-63.

65. Jovanovic-Peterson L., Peterson C.M. Vitamin and mineral deficiencies which may predispose to glucose intolerance of pregnancy. J Am Coll Nutr 1996; 15: 14-20.

66. Aharoni A., Tesler B., Paltieli Y., et al. Hair chromium content of women with gestational diabetes compared with nondiabetic pregnant women. Am J Clin Nutr 1992; 55: 104-7.

67. Mahalko J.R., Bennion M. The effect of parity and time between pregnancies on maternal hair chromium concentrations. Am J Clin Nutr 1976; 55: 104-7.


Для цитирования:


Ткачева О.Н., Полятыкина Т.С., Мишина И.Е., Барабашкина А.В. Метаболические расстройства и артериальная гипертензия в период беременности: ближайшие и отдаленные последствия для матери и плода. Кардиоваскулярная терапия и профилактика. 2006;5(8):101-108.

For citation:


Tkacheva o.N., Polyatykina T.S., Mishina I.E., Barabashkina A.V. Metabolic disturbances and arterial hypertension in pregnancy: short- and long-term effects on mother and fetus. Cardiovascular Therapy and Prevention. 2006;5(8):101-108. (In Russ.)

Просмотров: 20


Creative Commons License
Контент доступен под лицензией Creative Commons Attribution 4.0 License.


ISSN 1728-8800 (Print)
ISSN 2619-0125 (Online)