PERINATAL ASPECTS OF DELIVERY OF WOMEN WITH OBESITY AND GESTATIONAL DIABETES
Authors: Zhelezniakov O. , Lazurenko V. , Vasylieva I. , Frolova T. , Safonov R. , Liashchenko O. , Ovcharenko O. 
Published: December 2024

Obesity increases the likelihood of hypertension and pre-eclampsia and increases the risk of thrombosis in pregnant women, which can lead to thromboembolism and maternal and fetal death. Obesity most commonly increases the incidence of gestational diabetes mellitus (GDM) in pregnant women. GDM in the setting of obesity can complicate the process of childbirth, causing difficulties during delivery of the fetus (shoulder dystocia, birth trauma, fetal distress, etc.) and increase the rate of cesarean section (CS) delivery.
The aim of the study was to determine the characteristics of the delivery of women with obesity and gestational diabetes mellitus and to optimize the provision of obstetric care to them in order to reduce perinatal complications.
Materials and methods of the study. Examination, antepartum preparation and delivery of 136 pregnant women were performed, including 33 (24.3%) obese women (group 1), 35 (25.7%) obese women and GDM (group 2), 38 (27.9%) with GDM (group 3) and 30 (22.1%) women with physiological pregnancy formed the 4th (control) group. The traditional method (PG E2 - dinoprostone intravaginally) followed by induction and the complex method (insertion of a Foley catheter into the cervical canal followed by oral administration of prostaglandin E1 (PG E1) were used to prepare for childbirth.
The study was conducted in accordance with the principles of good clinical practice (GCP, 1996), the Convention of the Council of Europe on Human Rights and Biomedicine (April 4, 1997), the Declaration of Helsinki of the World Medical Association for the Ethical Principles of Medical Research with Human Subjects (1964-2008), and the Order of the Ministry of Health of Ukraine from 23.09.2009 № 690 (amended by the Order of the Ministry of Health of Ukraine from 12.07.2012 № 523). The draft of the study was discussed and approved at the meeting of the Medical Ethics Committee of KhNMU (Protocol ¹ 23 of November 13, 2024).
Statistics. Statistical processing was performed using the MS Excel software package. The Mann-Whitney U test, mean and standard deviation (M±m), and standard error (p) were used to compare quantitative data. At the level of probability of error (p<0.05), the results of comparisons were considered reliable.
The work was carried out within the framework of the research plan of the Department of Obstetrics and Gynecology No.2 of KhNMU: "Improvement of diagnostic and therapeutic measures and prevention of pregnancy complications and gynecological diseases in women with extragenital pathology (state registration number 0124U002218).
Results. Doppler examination of the hemodynamics of the fetoplacental complex in pregnant women revealed signs of uteroplacental and fetoplacental circulation disorders in 5 (15.5%) obese pregnant women, in 8 (22.9%) women with combined pathology (GDM in the setting of obesity), in 4 (10.5%) women with GDM, which was considered as placental dysfunction. Fetal anomalies according to CTG with STV (short-term variation) were observed in 6 (18.2%) obese pregnant women, 5 (15.2%) women with obesity, and 4 (10.5%) women with GDM.
According to the results of ultrasound cervicometry in pregnant women in the control group, the average length of the cervix was 18.7±2.3 mm, which is considered promising for spontaneous delivery. The size of the cervical canal in pregnant women with GDM and obesity was 30.1±2.7 mm, in pregnant women with GDM - 27.3±2.6 mm, in obese women - 25.2±2.9 mm, significantly different from the control group (p<0.05).
Conclusions. Childbirth in women with obesity and GDM is associated with several obstetric complications, in particular premature rupture of membranes, weakness of labor, fetal distress, clinically narrow pelvis, ineffective induction of labor leading to a high percentage of cesarean sections, and perinatal morbidity (neonatal asphyxia, diabetic fetopathy, hypoglycemia, CNS disorders). Effective completion of pregnancy and delivery without maternal and neonatal complications in women with GDM and obesity depends mainly on the state of the cervix before delivery, which is assessed by various methods (Bishop's scale, cervicometry, optimally using elastography). The best way to prepare for childbirth is a comprehensive process with a Foley catheter and PGE1, and induction with a half dose of oxytocin combined with epidural anesthesia, which reduces the rate of cesarean section and perinatal complications for both mother and fetus.