Obesity as factor of development of metabolic deviations in gestational diabetes

Objective — to evaluate the pathophysiological role of obesity in the development of metabolic disorders in women with gestational diabetes (GD). Materials and methods. 125 pregnant women were examined, including 33 obese patients, 32 pregnant women with GD, and 37 women with comorbidity of GD and obesity. The control group was represented by 23 practically healthy pregnant women. The content of proinflammatory cytokines (interleukin1b (IL‑1b), IL‑6, IL‑17, tumour necrosis factor a (TNFa)), C‑reactive protein (CRP) and glucometabolic profile were determined. Results. An integral analysis of the incidence structure of degrees of obesity by group established a statistically significant increase in degrees of obesity in women with combined pathology. The HOMA‑IR insulin resistance index was statistically significantly higher in obese patients by 1.1 times (p <0.05) compared with isolated GDM and by 2.5 times (p <0.001) compared with the control group, with a combined course of GDM and obesity — by 1.2 times (p <0.001) and 2.7 times (p <0.001), respectively. The indicators of the obesity group and the comorbidity group differed by 1.1 times (p <0.001). The median CRP content in pregnant women with GD and obesity was 8.12 mg/l, in obese patients — 6.95 mg/l, and in patients with GD — 4.47 mg/l. These results exceeded the control values (2.67 mg/l) by 3.04 (p <0.001), 2.6 (p <0.001) and 1.7 (p <0.001) times, respectively. The results of studying the activity of proinflammatory cytokines showed their significant overexpression in all study groups, but the deviations were more pronounced in women with comorbidities of GD and obesity. Correlations were revealed between parameters of the glucometabolic profile and markers of inflammation, as well as strong positive correlations between body mass index and levels of IL‑17 (r=0.91; p <0.01), IL‑6 (r=0.89; p <0.01), IL‑1b (r=0.94; p <0.01), TNF‑α (r=0.88; p <0.01) and CRP (r=0.86; p <0.01) in women with comorbid pathology. Conclusions. The presence of concomitant obesity in women with GD is characterized by the intensification of the meta‑inflammatory phenotype, which is manifested by significantly more pronounced expression of pro‑inflammatory biomarkers — cytokines IL‑1b, IL‑6, IL‑17, TNF‑α, and CRP, and is associated with statistically deeper deviations of the glucometabolic profile, progression of insulin resistance and deterioration of the course of GD compared to isolated pathology.