Disfunção metabólica gestacional e sua possível influência na programação metabólica neonatal

Abstract

As one of the major public health problems in the world, obesity can affect, directly or indirectly, the function of several organs and systems, leading to the development of other noncommunicable diseases, in addition to hormonal and/or nutritional changes that, associated with the maternal metabolic state (especially at pregnancy), influence the fetus and/or newborn (NB) programming a metabolic syndrome phenotype in the offspring. Adequate prenatal monitoring of the mother's metabolic condition is crucial to mitigate the installation of metabolic dysfunctions in the baby, which can last throughout life. In this study, we aimed to evaluate the relationship between maternal obesity during pregnancy and the NB’s anthropometric and metabolic parameters. This is a longitudinal, quantitative, and analytical study carried out with pregnant women and their respective NB. Pre-pregnancy and gestational data were collected, as well as blood samples from the umbilical cord at birth and milk samples throughout the first five months postpartum. Information from the live birth certificate was also collected and the NB's growth was subsequently monitored. There was no increase in body weight gain in pregnant with obese (P>0.05), however, when compared to eutrophic pregnant, there was a reduction in T3 values (27%) and an increase in insulin values (80.5%), HOMA-IR (54%), triglycerides (55%), TyG index (4.3%), cortisol (21%), total cholesterol (37.3%), VLDLcholesterol (39 %) and LDL-cholesterol (55%), as well as in heart rate (7.2%) in pregnant women with obesity (P<0.05). As for NB, an increase in head circumference (5.1%) and greater weight gain at birth (9.3%) were observed, as well as greater weight gain (5.3%) during the first five months of the children from women with obesity, when compared to the children of eutrophic women (P<0.05). Regarding the biochemical composition of breast milk, women with obesity showed a reduction in total cholesterol (18.3%), total proteins (21%), triglycerides (7.4%) and calcium (7%) when compared to eutrophic women. Furthermore, women with obesity had a fat content reduced by 38.2% and energy value reduced by 0.34% compared to eutrophic women (P<0.05). The umbilical cord blood of women with obesity showed an increase of 41.4% in glucose and 20% in total proteins (P<0.05). In summary, maternal obesity is associated with the development of hyperinsulinemia, insulin resistance, dyslipidemia and a slight increase in heart rate, as well as less energetic breast milk, in addition to increased head circumference and weight gain in the children of mothers with obesity.