Postpartum obesity is an endocrine-metabolic disorder that develops in women within 3-12 months after the birth of a child. The formation of postpartum obesity is associated with impaired hypothalamic function. The disease manifests itself progressively by weight gain, inulin resistance, the development of type 2 diabetes mellitus, sometimes occurring with insulin deficiency. Later there are complications characteristic of the metabolic syndrome. Diagnostics includes the study of hormone levels, instrumental methods. Conservative methods of therapy are used, aimed at correcting hormonal abnormalities, reducing the symptoms of pathology.
ICD 10
E66.8 Other forms of obesity
General information
Postpartum obesity is considered a neuro-metabolic-endocrine syndrome, which resembles a mild form of Cushing’s disease in manifestations. The prevalence of obesity among European women is 28%, after childbirth, excess of the norm of body mass index is observed in 59% of women. The prevalence of obesity is constantly growing. There is a connection with the existing endocrine disorders, the lability of the hypothalamic-pituitary system, complications during pregnancy and childbirth. Hormonal disorders leading to obesity can occur not only after childbirth, but also after abortion.
Causes
The prerequisites for the formation of postpartum obesity are laid even before pregnancy. The functional activity of brain structures is affected by infectious diseases and neuroinfections suffered in childhood. Intoxication, severe diseases during puberty can also become predisposing factors for the development of postpartum obesity. The connection of metabolic disorders with the following conditions has been established:
- Pregnancy complications. Neuroendocrine abnormalities occur after gestational diabetes mellitus, gestosis, infections suffered during the gestation period. Stress factors, eating disorders during pregnancy contribute to postpartum obesity.
- Severe course of labor. Postpartum obesity occurs due to prolonged labor, which took place with a violation of uterine contractility, bleeding in the postpartum or postpartum period. Infectious complications, cesarean section also lead to a violation of the functional activity of the hypothalamus.
- Endocrine diseases. The risk of postpartum obesity increases in women with diabetes mellitus, hypothyroidism. Endocrine disorders may not be previously diagnosed and manifest themselves already during pregnancy, and their complications ‒ after childbirth.
- Hereditary predisposition. In young women with postpartum obesity, parents often have diabetes mellitus, impaired glucose tolerance, or obesity that developed at a young age. Sometimes there are pathologies of the reproductive function, the adrenal glands, which lead to excess weight.
Pathogenesis
Postpartum obesity is triggered by a violation of the production of neurotransmitters that are involved in the regulation of the synthesis of releasing homones to adrenocorticotropin and gonadotropins. Under the influence of pathogenic factors, the synthesis of 3-endorphin increases and the formation of dopamine decreases. This leads to the maintenance of increased secretion of ACTH and prolactin. Adrenocorticotropic hormone stimulates the adrenal cortex, enhancing the synthesis of cortisol, aldosterone and sex steroids. But functional changes do not cause hyperplasia of the cortical substance.
Cortisol belongs to catabolic hormones, it regulates fat, carbohydrate, protein metabolism, and is an insulin antagonist. Its synthesis is also enhanced under the influence of estrogens, which are physiologically increased when carrying a child. In the postpartum period, hypercortisolemia occurs again with hormonal imbalance. The concentration of lipids and glucose in the blood increases. The kidneys retain sodium and water, which contributes to the formation of edema. Cortisol increases the sensitivity of blood vessels to catecholamines, postpartum obesity is often accompanied by arterial hypertension.
Classification
No special classification of postpartum obesity has been developed. Its degrees are determined by the body mass index ‒ the ratio of a woman’s weight in kilograms to her height in meters squared. BMI indicators are evaluated according to the standards established by the World Health Organization. The index of 18.5-24.9 kg/m2 is considered the norm. Obesity is preceded by overweight with a BMI of 25-30.
- 1 degree of obesity. BMI 30-35, the risk of developing cardiovascular pathologies, kidney damage increases, periodic hyperglycemia or type 2 diabetes mellitus may occur.
- 2 degree of obesity. Corresponds to BMI 35-40, there is a pronounced increase in body weight, at this stage, pathologies of the heart or blood vessels are already forming, menstrual cycle disorders occur, diabetes.
- 3 degree of obesity. Morbid form of pathology. BMI is more than 40. There is a lesion of the cardiovascular, excretory system, liver. Severe complications are added.
Symptoms of postpartum obesity
During the year after childbirth, body weight increases by 10-25 kg. Brain structures are involved in the pathogenesis of the disease, therefore hypothalamic symptoms are added: sleep disorders, changes in appetite, hunger, thirst. May be disturbed by mood lability, headaches. There are fat deposits on the body, often fat is deposited by the type of apron, arms and legs remain normal. With a BMI of more than 30 kg/m2, obesity develops according to the male type, when fat is deposited in the upper part of the trunk, between the internal organs and on the abdomen.
The menstrual cycle is disrupted a second time. He can’t recover even after stopping lactation. Initially, there is an insufficiency of the luteal phase, later anovulation joins – the egg does not mature. Menstruation is delayed for several weeks, breakthrough bleeding occurs or amenorrhea and infertility occur. Against the background of obesity, hyperplastic processes of the reproductive organs often occur: endometrial hyperplasia, adenomyosis, fibroids. Insulin resistance leads to an increased level of glucose in the blood, which is manifested by a feeling of constant thirst, polyuria.
With severe postpartum obesity, hyperpigmentation of the skin occurs, due to its thinning, striae appear. Stimulation of the adrenal cortex enhances the synthesis of androgens, which is manifested by hirsutism, increased greasiness of the skin and hair, and a tendency to acne. Metabolic disorders characteristic of postpartum obesity increase the likelihood of the formation of polycystic ovary syndrome, which subsequently becomes the cause of infertility.
Complications
With an untimely visit to the doctor, neurotransmission disorders pass from the functional stage to the organic one, which is difficult to treat. Diabetes mellitus, hypertension, polycystic ovary syndrome can become a complication of postpartum obesity. The lack of treatment leads to a gradual progression of pathology, the development of left ventricular hypertrophy, nephropathy, atherosclerosis. The probability of thrombosis increases. Severe vascular complications may occur in the form of a heart attack or stroke. Diabetes mellitus eventually turns from an insulin-resistant form into a deficient type, in which it is necessary to inject insulin.
Diagnostics
Noninvasive methods are used to diagnose postpartum obesity, which make it possible to exclude organic pathology of the hypothalamus, pituitary gland or adrenal cortex. During examination and diagnosis, it is necessary to take into account metabolic disorders that occurred in a pregnant woman or existed long before conception. Consultation of an endocrinologist and a therapist is necessary.
- Physical examination. The uneven distribution of adipose tissue is determined, the thickness of the skin fold on the abdomen is measured. Weighing and height allow you to calculate BMI. Visual examination shows signs of hyperandrogenism, striae on the abdomen and thighs, which appeared after childbirth.
- Laboratory diagnostics. Cortisol, ACTH, prolactin, and insulin are elevated in the blood. Sometimes it is possible to increase testosterone, and luteinizing and follicle-stimulating hormones remain within normal limits. Biochemical analysis shows dyslipidemia with an increase in cholesterol and low-density lipoproteins, triglycerides, glucose.
- Instrumental diagnostics. Ultrasound of the abdominal cavity and retroperitoneal space is necessary. It allows you to identify signs of adrenal tumors, changes in reproductive organs. To diagnose the condition of the pituitary gland, an MRI or CT scan of the brain is used. Postpartum obesity does not lead to pathological changes in these structures.
Treatment of postpartum obesity
Therapy is carried out in a complex, hospitalization in the department of endocrinology is not required. The difficulty lies in the fact that in order to restore menstrual function, it is necessary to reduce weight. Therefore, a nutritionist participates in the treatment together with a gynecologist. Therapy methods are selected depending on the severity of symptoms of postpartum obesity and concomitant pathologies.
- Diet therapy. Fractional meals in small portions are recommended. It is necessary to reduce the amount of simple carbohydrates and salt, fatty foods. Women with overweight and hyperglycemia may be recommended to eat bread units.
- Physical therapy. An increase in mobility leads to the consumption of calories, acceleration of the basal metabolism. The load increases gradually, after several training courses with stable positive dynamics, you can switch to other types of classes.
- Psychotherapy. It can be included in the complex of treatment of young mothers with obesity. The help of a psychotherapist is necessary for depressive disorders, a decrease in self-esteem, a tendency to jam stress and problems. Behavioral psychotherapy is used, aimed at developing self-control.
- Hormone therapy. Bromocriptine preparations can be used to reduce prolactin and normalize dopaminergic metabolism. Treatment of anovulation is carried out only after weight loss. Against the background of postpartum obesity with menstrual disorders, gestagens are used from the 16th to the 25th day of the cycle.
- Non-hormonal drugs. In insulin-resistant diabetes caused by postpartum obesity, metformin is prescribed. If diet and psychotherapy methods are ineffective, drugs are used to reduce lipid absorption, as well as appetite suppressants.
Prognosis and prevention
With timely treatment, postpartum obesity is amenable to correction, the risk of severe complications is reduced. Prevention consists in maintaining optimal body weight throughout life, sufficient physical activity. Metabolic disorders can be avoided by reducing the level of stress in everyday life. Pregnant women should follow the doctor’s recommendations, eat a balanced diet, and not overeat. Moderate physical exertion benefits pregnant and postpartum women, and physical inactivity increases the likelihood of metabolic disorders.
