The aim of the study was to determine the association of serum leptin levels in pregnant women with the risk of hypertensive disorders depending on gestational weight gain (GWG). We have studied 190 pregnant women with a normal pre-pregnancy body mass index, who were registered at the City Clinical Perinatal Center, Ivano-Frankivsk, Ukraine. Quantitative determination of leptin in serum was performed by ELISA Kit (CAN-L-4260, Canada). Statistical analyses based on Microsoft Excel statistical analysis package and Statistica 6.0. Gestational hypertension (GH) has developed in 29 (15.3 %), preeclampsia in 39 (20.5 %) cases and 122 (64.2%) pregnant were normotensive. The recommended GWG (11.5-16.0 kg) was diagnosed in 133 (70.0 %), excessive in 57 (30.0 %) patients. The frequency of GH was 2.2-fold (p<0.05) and preeclampsia was 4.2-fold (p<0.001) higher in pregnant with excessive GWG, compared to patients with the recommended GWG. Leptin concentrations in pregnant with GH were 1.5-fold in the third trimester (p<0.01), and with preeclampsia 1.1-fold in the second (p<0.01) and 1.5-fold in the third (p<0.01) trimesters higher compared to normotensive women. Serum leptin concentrations of pregnant with GH and preeclampsia were significantly higher in the group with excessive GWG compared to the recommended, which were detected in the second trimester. A high degree of risk of hyperleptinemia in the groups of pregnant with GH (OR=3.50; 95%CI: 1.48-9.33; p<0.05), and with preeclampsia (6.01; 2.43-15.02) was found in women with excessive GWG. A positive correlation was found between leptin concentration, GWG and body fat percentage in pregnant with GH and preeclampsia in the second and third trimesters. Thus, leptin can be considered a marker of the association between pathological GWG and hypertensive disorders in pregnancy
The goal of this study was to determine the association between the level of 25-(OH) vitamin D and excessive body weight in women on preconceptional period and during gestation. There were studied 117 women. The first group included 68 overweight women (body mass index (BMI) 25.0-29.9 kg/m2), the second – 49 with normal body weight (BMI 18.5-24.9 kg/m2) before prepregnancy. Anthropometry was performed, BMI (kg/m2) by Quetelet formula. The 25-(OH) vitamin D blood serum level was studied by immunoenzymatic method. Fasting blood serum levels of glucose, insulin were determined by the immunoenzymatic method, insulin resistance index was calculated, serum concentrations of triglycerides, total cholesterol, high, low and very low density lipoproteins were determined. The results were statistically analyzed using Statistica 10 (Serial Number: STA999K347150-W) and MEDCALC®. It was found an inverse correlation between the level of vitamin D and BMI (r= – 0.71, p<0.001). Excessive body weight on preconceptional period reduces the chances of an adequate level of vitamin D (0.02; 0.00-0.10; p<0.001) and increases the chances of its deficiency (13.11; 4.89-35.30; p<0.001) during early gestational period. It was diagnosed that during pregnancy, the chances of vitamin D deficiency increase in women with normal body weight (3.16; 1.11-9.02; p=0.04), but remain significantly higher in the overweight (6.30; 2.80-14.18; p<0.001). It was shown that insufficiency/deficiency of vitamin D during pregnancy was accompanied by insulin resistance, hyper/dyslipidemia, which are the metabolic basis of gestational complications. The assessment of an inverse relationship between the level of 25-(OH) vitamin D and excessive body weight in women on preconceptional period and the increase of deficiency during pregnancy should be taken into account for the purpose of laboratory determination of the vitamin at the stage of pregnancy planning for the appointment of therapeutic correction.
The article shows the role of clinical practice in Obstetrics and Gynecology in the context of the implementation of a competency-based approach to the organization of education of modern students. The indisputable advantages of the orientation of the educational process onto the achievement of professional competencies for the training of competitive specialists with flexible practical-meaningful thinking are determined. Priority in the system of medical education is the development of new approaches, methods and forms of training in order to form readiness for the professional activity of a medical specialist. The efficiency of algorithmization and pedagogical potential of the case-method in the structure of clinical practice teaching is proved.
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