DYNAMICS OF MATERNAL SERUM BLOOD LEPTIN LEVEL DURING PREGNANCY COMPLICATED WITH HYPEREMESIS GRAVIDARUM
Hyperemesis gravidarum, a pregnancy-related condition characterized by severe nausea and vomiting, occurs in 0.5 % to 2 % of all pregnancies. Hyperemesis gravidarum causes dehydration, electrolyte and metabolic disorders, nutritional deficiency, leading to ketonuria and/or ketonemia. Progressive deterioration requires hospitalization and drug therapy, associated with decreased patient quality of life and depression, increased risk of preterm delivery and the birth of small for gestational age children. There are studies that indicate the effect of hyperemesis gravidarum on insufficient gestational weight gain (GWG), but the metabolic support of this relationship requires further study.
Aim. To determine the dynamics of serum blood leptin level in women during pregnancy, complicated by hyperemesis gravidarum, in relation to gestational weight gain.
Materials and methods. A prospective study was carried out at the Ivano-Frankivsk City Clinical Perinatal Center, Ukraine. 109 pregnant women with hyperemesis gravidarum were included and 54 pregnant without hyperemesis gravidarum as a control group. Prepregnancy body mass index (BMI) was 20.2±1.8 kg/m2, which corresponded to the normal weight due to recommendations of the Institute of medicine in the USA (2009) and the Order of the ministry of health of Ukraine № 417 (2011). Exclusion criteria: age up to 18 years, multiple pregnancy, pregnant women with delivery before 37 weeks, vomiting after 22 weeks of pregnancy, the presence of severe chronic somatic diseases. Examination of women was performed in each trimester of pregnancy (9-12, 22-24, 37-40 weeks). BMI was calculated by the Kettle formula (1865): the ratio of body weight (kg) to the square of height (m2). Quantitative determination of leptin in serum was performed by ELISA Kit (CAN-L-4260, Canada). Statistical analyses were carried out using "Statistica 6.0" (StatSoft Inc., USA) and a Microsoft Excel-based statistical analysis package. The differences between the selections were considered statistically reliable at p<0.05 (Tukey’s test).
Results. Serum blood leptin level of the patients with hyperemesis gravidarum was found to be significantly higher in 1.3 times in the second trimester (p<0.01) and in 1.5 times in the third trimester (p<0.05) compared to early terms, but in mid-pregnancy the concentration of leptin was 1.2 times significantly lower those in the control group (p<0.05). In the second trimester in the group with hyperemesis gravidarum the chances of insufficient GWG in 3 times (OR=3,01; 95% CI: 1,34-6,80; p<0,05) were diagnosed higher (in 41 (37.6%) pregnant women against 9 (16.7%) in the control group). A positive correlation was found between the concentration of leptin in the second trimester and GWG in patients with hyperemesis gravidarum (r=0.83, p<0.001).
Conclusions. Decreased maternal leptin levels in the second trimester with hyperemesis gravidarum may be a predictor of insufficient gestational weight gain.
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