Longitudinal Measures of Leptin in Pregnant Women Who Developed Preeclampsia

1. Introduction Obesity and type 2 diabetes (2DM) are worldwide health issues, and the incidences of both diseases are increasing rapidly. Recent research has shown that maternal nutrition during pregnancy may have long-term metabolic consequences in offspring. Many pregnant women are obese (body mass index (BMI) > 30 kg/m2). The prevalence of maternal obesity is rising, up to 20% in some antenatal clinics, which is in line with the prevalence of obesity in the general population. Obesity in pregnancy has been linked to several adverse pregnancy outcomes, including spontaneous abortion, preeclampsia, gestational diabetes (GDM), fetal macrosomia, cesarean delivery, and wound complications post-cesarean section. Both intrapartum and postpartum management of obese gravidas require multidisciplinary consultations between obstetricians, anesthesiologists, nurses, and pediatricians in order to improve the pregnancy outcomes of the mother and neonate. The American College of Obstetricians and Gynecologists (ACOG) and several authors currently support risk-reducing strategies for obese pregnant patients including limiting weight gain.

Preeclampsia is a multisystem disorder characterized by pregnancy-induced or gestational hypertension and new-onset proteinuria during the second half of pregnancy.

The aim of this study was to measure leptin in lean, obese and diabetic pregnant women at three-month intervals throughout their pregnancies to determine if this hormone could serve as a prognostic marker for preeclampsia risk.

Recruitment Women were recruited at their first visit at 10-15 weeks gestation. They were asked to attend after an overnight fast and were tested between 0700 and 0900 h. Three groups of pregnant women were formed: a) normal weight (pregestational (PG) BMI < 25 kg/m2), b) overweight-obese (PGBMI ≥ 25 kg/m2) and c) hyperglycemic in the first trimester of pregnancy confirmed as GDM in women previously known to be normoglycemic. Positive cases for preeclampsia were then subdivided.

Clinical follow-up Three examinations were performed in the 1st, 2nd, and 3rd trimesters. In each visit, the women were weighed. Blood pressure (BP) was recorded at each visit using a standard sphygmomanometer and appropriately sized cuff. If diagnosed with pregnancy-induced hypertension, the women were hospitalized and clinically supervised with an electronic monitor (Mercury, Mennem Medical) until the diagnosis of preeclampsia was confirmed or excluded.