Preeclampsia and Obesity-The Preventive Role of Exercise

Abstract

Obesity is now recognized as a worldwide epidemic. An inadequate diet and reduced physical activity are acknowledged as the leading causes of excess body weight. Despite growing evidence that obesity is a risk factor for unsuccessful pregnancies, almost half of all women who become pregnant today are overweight or obese. Common complications of pregnancy in this group of women are preeclampsia and gestational hypertension. These conditions are also observed more frequently in women with excessive weight gain during pregnancy. Preeclampsia is one of the most serious pregnancy complications with an unpredictable course, which in its most severe forms, threatens the life and health of the mother and her baby. The early identification of the risk factors for preeclampsia development, including obesity, allows for the implementation of prophylaxis and a reduction in maternal and fetal complications risk. Additionally, preeclampsia and obesity are the recognized risk factors for developing cardiovascular disease in later life, so prophylaxis and treating obesity are paramount for their prevention. Thus, a proper diet and physical activity might play an essential role in the prophylaxis of preeclampsia in this group of women. Limiting weight gain during pregnancy and modifying the metabolic risk factors with regular physical exercise creates favorable metabolic conditions for pregnancy development and benefits the elements of the pathogenetic sequence for preeclampsia development. In addition, it is inexpensive, readily available and, in the absence of contraindications to its performance, safe for the mother and fetus. However, for this form of prevention to be effective, it should be applied early in pregnancy and, for overweight and obese women, proposed as an essential part of planning pregnancy. This paper aims to present the mechanisms of the development of hypertension in pregnancy in obese women and the importance of exercise in its prevention.

Keywords: exercise; gestational hypertension; obesity; preeclampsia; prophylaxis.

Figure 1

Main features of preeclampsia and obesity. IL-6—interleukin 6, TNFα—tumor necrosis factor α, IL-1β—interleukin 1 β, CRP—C-reactive protein, NO—nitric oxide, ROS—reactive oxygen species, VCAM-1—Vascular Cell Adhesion Molecule 1, ICAM-1—Intercellular Adhesion Molecule 1, PPARγ—Peroxisome Proliferator-Activated Receptor-γ, TXA2—thromboxane A2, ERS—endoplasmic reticulum stress.

Figure 2

The effects of exercise on pathophysiological elements of PE development. IL-6—interleukin 6, IL-10—interleukin 10, IL-15—interleukin 15, FGF 21—fibroblast growth factor 21, TNFα—tumor necrosis factor α, IL-1β—interleukin 1 β; NO—nitric oxide, ROS—reactive oxygen species, sFlt1—soluble fms-like tyrosine kinase-1, VEGF—vascular endothelial growth factor, PlGF—placental growth factor, HSP_s—heat shock proteins, AMPK—5′ adenosine monophosphate-activated protein kinase, TLR 4—Toll-like receptors 4, VCAM-1—Vascular Cell Adhesion Molecule 1, ICAM-1—Intercellular Adhesion Molecule 1.

Figure 3

The principles of introducing and expanding physical exercise in pregnancy.