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MODERN VIEW OF THE PROBLEM OF OBESITY IN WOMEN OF A REPRODUCTIVE AGE
Tagiyeva Fakhriya Alamdar, Azerbaijan Medical University, doctor, of Philosophy in Medicine, Department of Obstetrics and Gynecology II
Baku, Azerbaijan E-mail: [email protected]
MODERN VIEW OF THE PROBLEM OF OBESITY IN WOMEN OF A REPRODUCTIVE AGE
Abstract: Obesity has a negative impact on the reproductive health of women and is a serious obstetric problem. Pregnancy, childbirth and the early postpartum period in obese women occur with a large number of complications. With obesity, the mother's frequency of unfavorable outcomes for the fetus and the newborn increases. Keywords: obesity, women, pregnancy.
The priority direction of modern medicine is the improvement of the protection of motherhood and childhood. It remains important to study the influence of extragenital diseases in a woman on the course of pregnancy and childbirth, on the development of the fetus and the newborn. Somatic diseases that occur before and during pregnancy, always affect the course of pregnancy, childbirth and the postpartum period. In this connection, the interest of researchers to the problem of obesity in women of reproductive age has recently increased significantly [1, 2, 3].
Obesity is an excessive accumulation of adipose tissue in the body, characterized by a violation of lipid and carbohydrate metabolism with subsequent pathological changes. This pathology can be caused by the impact of both external and internal causes. It is believed that in 35-50% of cases obesity is associated with the influence of environmental factors and genetic factors [4, 5]. The distribution of fat can also influence non-genetic determinants: steroid hormones, cortisol, insulin. There is evidence of a link between the development of obesity and pregnancy, when obesity appears and develops after the first pregnancy [6, 7].
In economically developed countries, at least 30% of the population is overweight [8]. Currently, in most countries of Western Europe, 10 to 25% of the population suffers from obesity, up to 40% in the United States [8]. The urgency of the problem of obesity is also in the fact that the number of people who are overweight is progressively increasing.
The etiopathogenetic classification divides obesity into primary and secondary forms [9]. Primary obesity, which accounts for 90-95% of all cases of the disease, is divided into alimentary-constitutional and neuroendocrine (hypothalamic) forms [4, 9]. Secondary or symptomatic obesity includes endocrine-metabolic obesity (obesity in Cushing's syndrome, hypothyroidism, acromegaly and insuloma), and cerebral obesity associated with diseases and brain damage [9].
In recent years, there has been a tendency to subdivide obesity based on the distribution of fat to the abdominal, when the bulk of the fat is located in the abdominal cavity, in the anterior abdominal wall, trunk, neck and face (male or android type of obesity) and gluteo-fumoral - with the predominant fat deposition on the buttocks and hips (female or gynoidal type of obesity) [4, 9, 10].
There are conflicting opinions on the role of age factors in the development of obesity [4, 10]. In women, twice as often, compared with men, obesity is formed at a younger age [1, 4, 10]. However, already among the girls aged 16 19 years, obese patients are many (30%), and the duration of obesity, despite the young age, in 50% of them exceeds 10 years [1,2].
Overweight is clearly associated with a multiple increase in the risk and frequency of development of arterial hypertension, non-insulin-dependent diabetes mellitus, atherosclerosis and coronary heart disease [4, 9, 11]. Primary forms of obesity, regardless of the etiological factors, are accompanied by metabolic disorders and pathological functioning of the reproductive system [12].
Until the present time is not set, which factors are decisive in the occurrence or progression of obesity and how it affects the morphological and functional characteristics of the reproductive system. Many aspects of the pathogenesis, classification and effects of obesity on reproductive health remain controversial [13, 14]. This applies, first of all, to women of active reproductive age.
So, if the age of 30-36 years was considered critical for the development of obesity, in recent years, this pathology is often formed in women aged 20-25 years [1, 2].
Women with obesity often experience the development of irregular menstrual cycles, hypomenstrual syndrome and secondary amenorrhea, acyclic bleeding [1, 2, 7]. In the reproductive age, postpartum obesity is more often associated with endocrine factors [3]. Often obesity develops during
Section 11. Medicine
pregnancy and progresses after childbirth. The incidence of postpartum neuroendocrine syndrome reaches 38% [15, 16].
Pregnancy, childbirth and the early postpartum period in obese women occur with a large number of complications. The number of pregnant women suffering from obesity is 15-38% [6]. Among pregnant women with obesity, women aged 21-25-30-32% and 26-30% - 26-30% predominate [13, 17].
Obstetrical pathology in women with obesity is a consequence of the violation of adaptive and compensatory-protective mechanisms. Various complications of pregnancy occur in 85% of patients with obesity, which is almost twice as often as in women with normal body weight [15, 17, 18]. In pregnant women with obesity, there is a need for hospitalization in connection with complications [19].
The most common complications in the combination of gestosis with obesity: polyhydramnios, untimely passage of amniotic fluid, hypotonic bleeding, anomalies of labor [3]. Heavy forms of gestosis in obese women are three times more common than in pregnant women with normal body weight [3]. When combining obesity with hypertension, late gestosis develops in 100% ofpregnant women [3]. Progressing obesity in pregnant women leads to the appearance of severe forms of gestosis, requiring early delivery [3, 20]. In pregnant women with gestosis on obesity, hypovolemia before delivery and in
the puerperium is more pronounced than in women with gestosis without obesity [3].
In second place, the frequency of occurrence is threatened with termination of pregnancy, both in early and late periods [16, 21]. Pathological hemorrhage in labor is a frequent complication in obesity [15].
With obesity, the mother also has an increased incidence of adverse outcomes for the fetus and the newborn [18, 19, 20, 22]. Reducing the body weight of newborns with obesity is the result of progressive placental insufficiency, leading to some lag in the development of the fetus [20]. Obesity of a pregnant woman is a risk factor for the development of chronic intrauterine fetal hypoxia due to the early formation of fetoplacental insufficiency. Endocrine disorders, characteristic of obesity, affect the fetoplacental blood circulation, contributing to the development of the patency of the placenta [15, 16]. At the root of the onset of chronic intrauterine hypoxia of the fetus, pregnant women with excess body weight suffer from a violation of utero-placental-fetal circulation [15, 16].
Thus, the consistently high proportion of obese women of the reproductive age gives reason to consider the problem of obesity as one of the important health problems of women of reproductive age. It can be argued that obesity, having a negative impact on the reproductive health of women, is a serious obstetric problem.
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MODERN VIEW OF THE PROBLEM OF OBESITY IN WOMENOF A REPRODUCTIVE AGE
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