Obesity and risks of maternal mortality

• Anton S. Olenev
• Kotaysh Galina A.
• Vladislavа A. Novikovа
• Igor N. Kostin
• Victor E. Radzinsky

Abstract

Obesity is a proven risk factor for severe complications of pregnancy. The relationship between body mass index (BMI) and the structure of maternal mortality (MM) is well known. The debate about whether obesity or the pathological processes caused by it (insulin resistance, inflammation, systemic inflammatory response syndrome, increased thrombosis, etc.) affect the pathogenesis of dysfunction of the organ (system) during pregnancy.

The aim of this study is to assess the role of obesity in the risks of maternal mortality among women in the Russian megalopolis.

Material and methods. A cohort retrospective multi-center scientific and analytical study was conducted. The analysis of the medical documentation of 98 cases of maternal mortality in 27 health facilities of the Russian metropolis for the period 2013 (January 1) - 2017 (December 31), was carried out.

Results. The age of women was 17-41 years (30.06±5.86 years); gestational age at MM - from 12 to 37 full weeks (22.92±8.91). In 35% of women in medical records there was no information on pregestational BMI, in 35% BMI was normal, in 13% deficit, in 17% it exceeded the norm. In MM, the proportion of women with a normal weight and outside the normal range remained the same. Revealed a significant difference in the age of women with normal weight and its excess, gestational age, in which MM in women with normal weight and its excess. 15.31% of women were socially disadvantaged. 62.24% of women were residents of the metropolis. Only residents of the metropolis weight of women with MM corresponded to the deficiency, normal, excess and obesity. A higher pregestational BMI corresponded to social well-being and higher weight in MS was in women with social welfare than in its absence. Various causes of MS (according to the ICD code) are associated with different weight characteristics of women. It was found that for a specific place of residence or weight of a woman there could be a characteristic cause of MS. With the help of automated neural networks, non-linear links were established between the social and weight characteristics of a woman, the gestational age of the MS that occurred and its cause.

Conclusion. The structure and fundamental differences in the causes of MM with deficiency and excess weight form the focus of studying the pathogenesis of severe complications of gestation provoked and/or exacerbated by obesity, which can expand the current understanding of its paradoxes. The reserve for reducing the MM is to reduce its conditionally preventable causes. Planning a pregnancy, understanding the degree of life threatening obesity by the woman herself, conducting effective social programs for introducing a healthy lifestyle and normalizing weight are the main components of preventing MS in obese women.

Keywords:maternal mortality, obesity, social malpractice, megalopolis

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