Mensuração da prevalência de sobrepeso/obesidade e da expressão placentária de apelina e visfatina em mulheres com pré-eclâmpsia: associação com variáveis maternas e fetais

Abstract

Preeclampsia (PE) is one of the main hypertensive complications associated with pregnancy, with an important impact on maternal-fetal morbidity and mortality rates. It is a placental disorder, multisystemic, idiopathic, and specific to the human pregnancy, being a multifactorial pathological entity influenced by the maternal genetic constitution, environmental and immunological factors, characterized by the development of arterial hypertension after the twentieth week of pregnancy, in women previously normotensive, associated to proteinuria and/or target-organs failure. Several factors are associated with PE, especially obesity. Obesity is one of the most common comorbidities in the 21st century, affecting more than 600 million people worldwide. The relationship between obesity and PE is explained, at least in part, by the production and release of adipokines by the white adipose tissue. Therefore, the present study aimed to assess the overweight/obesity prevalence and the apelin and visfatin expression in the placental tissue and to associate these variables with sociodemographic and clinical-laboratory variables, and fetal outcomes in samples from pregnant women with preeclampsia. In the first product, entitled “Prevalência de sobrepeso/obesidade e sua associação com fatores sociodemográficos, clínico-laboratoriais maternos e desfechos fetais em gestantes com pré- eclâmpsia”, were included 178 pregnant women and their respective newborns attended in the Maternity/obstetrics center in the Clemente de Faria Hospital, from the Universidade Estadual de Montes Claros (Unimontes). Information was collected from medical records and via interviews. The maternal and fetal characteristics evaluated were grouped in sociodemographic, clinical-laboratory, and fetal outcomes (conditions at birth). The odds ratio between the anthropometric categories and further variables was assessed, with a 95% confidence interval (CI), and significance set at p<0.05. The main findings displayed a 73.03% prevalence of overweight/obesity. Regarding the maternal conditions a statistically significant association for the preeclampsia personal history and previous pregnancies (>1 birth) was detected. Regarding the conditions at birth, a statistically significant association was verified for the cephalic perimeter, where pregnant women with overweight/obesity had three more chances to deliver babies with the cephalic perimeter < 33cm. In the second product, entitled “Expressão gênica de apelina e visfatina no tecido placentário de gestantes com pré-eclâmpsia: uma associação com variáveis clínicas, laboratoriais e antropométricas”, 60 pregnant women and their respective newborns were included. In addition to the maternal-fetal sociodemographic, clinical-laboratory, and anthropometric variables, samples from the placental tissue were obtained for the apelin and visfatin expression assessment via qRT-PCR. Mann-Whitney and Spearman correlation analysis were performed. Associations were observed between the apelin expression levels and maternal age, age at PE diagnosis, personal history of PE, PE clinical presentation, gender, and birth weight; and between visfatin expression levels and PE late diagnosis, gestational age at birth, birth weight, cephalic perimeter, and APGAR score at 1 and 5 minutes. Moreover, an inversely proportional correlation between apelin and pre-pregnancy BMI was observed. It is concluded that the study sample presented important percentages of overweight/obesity, being this variable and the apelin and visfatin expression associated with maternal-fetal conditions.