Dynamics of the Parameters of the Metabolic Syndrome in Obese Women Who Have Undergone Caesarean Section Under the Influence of Physical Therapy

Abstract

Purpose: to determine the effectiveness of restoring the health status of obese women who underwent cesarean section, based on the dynamics of metabolic syndrome parameters.
 Methods. During the research, 44 women aged 25.5±1.6 years at the end of the late postpartum period (2 months after childbirth) were examined. The control group consisted of 17 women with normal body weight who gave birth vaginally and recovered independently in the postpartum period. The comparison group consisted of 14 obese women who independently recovered in the postpartum period. The experimental group consisted of 13 obese women who, for 3 months, performed a physical therapy program (therapeutic exercises for the muscles of the back, abdomen, upper and lower limbs, functional training; pressotherapy; vacuum massage; nutritional recommendations. The criteria for metabolic syndrome were studied: abdominal obesity, fasting hyperglycemia, impaired glucose tolerance (according to the results of a 2-hour loading test), total cholesterol, high triglyceride content, decreased high-density lipoprotein content.
 Research results. During the observation period (3 months), the women of the control group increased their body weight by 0.61 kg on average, the comparison group - by 1.66 kg, while the women of the experimental group decreased their body weight by 2.57 kg, which was reflected in the dynamics body mass index. In the women of the research group, it was possible to achieve a statistically significant decrease in waist circumference (p<0.05), which can be explained not only by the decrease in the amount of abdominal fat, but also by the toning of the muscles of the anterior abdominal wall, weakened by overstretching during pregnancy. Such dynamics influenced the parameters of the ratio of waist circumference to hip circumference in the direction of its improvement, although normalization was not achieved. Under the influence of physical therapy, the expressiveness of biochemical manifestations of metabolic and dyslipidemic manifestations in the women of the research group decreased relative to the parameters of the first examination. Fasting glucose parameters reached the normal range, tissue sensitivity to glucose was restored. Positive changes in the concentrations of lipid fractions in the direction of decreasing atherogenicity were observed. At the same time, women in the comparison group showed a tendency to increase body weight, worsening of atherogenic dyslipidemia, i.e. signs of metabolic syndrome. In women of the control group with normal body weight, there were no changes in the studied indicators.
 Conclusions. Obesity as an independent pathological process increases the risks during pregnancy and childbirth for both the mother and the child, leading to an increase in the frequency of abdominal delivery with appropriate postpartum rehabilitation in such women. The improvement of anthropometric indicators and the reduction of dysmetabolic and dyslipidemic manifestations indicate the sufficient effectiveness of physical therapy in correcting body weight in women with obesity in the postpartum period, although in order to achieve normal body weight indicators and complete normalization of indicators, the duration of recovery measures should be longer than three months, and for all patients of this profile need lifelong adherence to a balanced diet.