Exzessive Gewichtszunahme in der Schwangerschaft und die prognostische Bedeutung des Apolipoprotein B

Zusammenfassung

Einleitung Exzessive Gewichtszunahme (EGZ) stellt einen Risikofaktor in der Schwangerschaft dar. Da die EGZ ebenso wie Hypertensive Schwangerschaftserkrankungen (HES) und die intrauterine Wachstumsrestriktion (IUGR) mit veränderten Konzentrationen Apolipoprotein B- (ApoB) haltiger Lipoproteine einhergehen, wurde der Hypothese nachgegangen, ob die ApoB-Konzentration im ersten Trimester diese Ereignisse vorhersagen kann.

Methoden Von 547 Schwangeren zeigten 95 eine unzureichende, 171 eine empfohlene und 281 eine EGZ. 23 Schwangere wiesen eine HES, 67 ein small for gestational age (SGA) Neugeborenes und sieben eine IUGR auf. Die ApoB-Konzentration wurden mittels ELISA in Serum der 11+0 bis 13+6 SSW bestimmt.

Ergebnisse Die mittleren ApoB-Konzentrationen der Patientinnen verschiedener Gewichtszunahme-Gruppen waren nicht signifikant unterschiedlich. Frauen mit Adipositas zeigten höhere ApoB-Konzentrationen als normalgewichtige (p<0,001). Patientinnen mit präexistentem Hypertonus sowie Raucherinnen wiesen erhöhte ApoB-Konzentrationen verglichen mit normotensiven Kontrollen (p=0,0015) und Nichtraucherinnen (p=0,0118) auf. Eine prognostische Bedeutung ließ sich in Bezug auf HES und IUGR/SGA nicht nachweisen.

Folgerung Die ApoB-Konzentration im ersten Trimester ist nicht für die Vorhersage einer EGZ oder Schwangerschaftskomplikation geeignet. Bei bestehenden pathologischen Zuständen wie Rauchen, Adipositas und chronischer Hypertonie sind die ApoB-Werte erhöht und könnten in diesen Gruppen zur Pathogenese von Schwangerschaftserkrankungen beitragen.

Abstract

Introduction Excessive maternal gestational weight gain (GWG) is a risk factor for maternal and fetal complications. The lipid profile changes physiologically during pregnancy. Weight gain can affect lipid metabolism. The hypothesis of the study was that apoB levels early in pregnancy are associated with excessive GWG and predictive for adverse outcomes.

Methods Out of 547 patients there were 95 women with inadequate GWG, 171 with adequate GWG, and 281 with excessive GWG. Out of 581 patients there were 14 patients with pregnancy-induced hypertonus/pre-eclampsia, 67 with small-for-gestational-age (SGA) infants, and 7 with fetal growth restriction (FGR). ApoB levels were measured by ELISA.

Results There was no significant difference in apoB levels between the different GWG groups. We found significantly higher levels of apoB in overweight and obese patients compared to those with normal BMI. Smoking was correlated with higher apoB levels. There were no differences either between women with PIH/PE and normotensive women or between SGA/IUGR and pregnancies without. Women with pre-existing hypertension showed significantly higher apoB levels than the control group.

Conclusions ApoB cannot be used as a marker for identifying the risk of excessive GWG or adverse pregnancy outcomes early in pregnancy. However, it may be involved in the pathophysiology of adverse pregnancy outcomes in high-risk patients.

Schlüsselwörter

Adipositas - Geburtshilfe - Schwangerschaft - Exzessive Gewichtszunahme - Lipide - Apolipoprotein B

Key words

adipositas - obstetrics - apolipoprotein B - lipid metabolism - excessive gestational weight gain - pregnancy

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