RU2797104C2 - Method of identifying the prerequisites for the appearance of preeclampsia in pregnant women and its timely prevention by aqua fitness - Google Patents

Abstract

FIELD: health-improving physical culture.

SUBSTANCE: invention relates to health-improving physical culture, in particular to swimming, namely to physical exercises in water, hydrokinesiotherapy, and can be used in the prevention of practically healthy, without obvious pathologies, pregnant women by aqua fitness. At all times, there has always been and there is an urgent problem of bearing and giving birth to a healthy child, associated with various reasons for the state of health of a pregnant woman, starting from the early stage of her pregnancy, due to the lack, in particular, of timely fixation in a pregnant woman of indicators preceding the onset of symptoms of preeclampsia and their operational corrections. The essence of the invention consists in the timely detection of controlled parameters of a pregnant woman's well-being, the determination of her inherent risk group, each of which is formed according to the complex values of the degree of manifestation of predictor markers. After that, for each pregnant woman from the corresponding risk group, an individual training complex of exercises is carried out under the control of predictor markers preceding the onset of symptoms of preeclampsia, which include gestational weight, outwardly pronounced edema, increased systolic and diastolic pressure relative to the norm, and decreased pulse pressure.

EFFECT: method provides a reduction in the possible risks of occurrence and development of preeclampsia.

1 cl, 9 tbl, 5 ex

Description

SUBSTANCE: invention relates to health-improving physical culture, in particular to swimming, namely to physical exercises in water, hydrokinesiotherapy and can be used in the prevention of practically healthy, without obvious pathologies, pregnant women, by means of aqua fitness.

Currently, there is an urgent problem of bearing and giving birth to a healthy child, associated with various reasons for the state of health of a pregnant woman, starting from the early stage of her pregnancy, due to the lack, in particular, of timely fixation in a pregnant woman of indicators preceding the onset of symptoms of preeclampsia and their prompt correction.

The most widely known drug methods for the prevention of preeclampsia, as well as methods using effective physical activity, incl. water procedures by aquafitness methods [1-11].

Among drug methods of prevention, there are methods [1-9], the main purpose of which is to isolate special biochemical prognostic markers, as well as preventive and/or symptomatic dosed administration of appropriate drugs.

In particular, there is a known method of medical prevention of preeclampsia [1] by the complex prescription of prophylactic doses of drugs, such as, for example, aspirin, duphaston and chimes, to pregnant women with established risk factors for developing preeclampsia, immediately after the fact of pregnancy is established. The main disadvantage of such drug prevention methods is their high drug load on the expectant mother and fetus.

There is a known method for the prevention of preeclampsia [2] in pregnant women with a burdened obstetric history by extracting DNA and prescribing vitamin D. The main disadvantages of this group of known methods are the complexity of their implementation, requiring costly and complex examinations of a pregnant woman.

There are known methods for predicting the development of preeclampsia in pregnant women [3-9], by analyzing clinical and genetic factors and isolating multiple biochemical and biophysical prognostic markers, the common disadvantage of which is the use of complex methods of special medical diagnostics that require a lot of time to detect symptoms of its manifestation, which eliminates the efficiency of the direct prevention of preeclampsia before the manifestation of its pronounced symptoms.

Among the methods using effective physical activity, incl. water procedures by the methods of aqua fitness, there is a known method [10], the main purpose of which is a complex preventive prophylactic effect with a focus on preclinical symptoms of preeclampsia with Limontar and Magne B6 in combination with physical exercises in the water, including a cycle of regular training sessions, with regular monitoring of both heart rate (HR) and blood pressure (BP) of pregnant women at the beginning and at the end of the session, taking into account individual contraindications for aqua fitness.

The disadvantage of this method is the low motor density of employment, insufficiently high level of load controllability (at the beginning and at the end of the lesson). Performing exercises in the conditions stated in the method does not allow full use of the positive properties of the aquatic environment, and dosed pulse loads are suitable only for a limited category of pregnant women who have a heart rate at rest does not exceed 80 beats / min. Dosing load for pregnant women, whose resting heart rate exceeds 80 bpm, in a known way, can potentially lead to uncontrolled overload for pregnant women and, as a result, to negative consequences and deterioration in their health.

There is a known method for the prevention of preeclampsia in pregnant women by means of aqua fitness, the closest in terms of solving the technical problem and the totality of general features to the claimed invention, adopted as a prototype [11]. The known method provides for the prevention of preeclampsia in pregnant women, which is carried out by conducting a cycle of regular 8-12 training sessions in the water, lasting 50-60 minutes each and including 40-50 exercises combined into blocks, including a distance swimming block, with constant comprehensive monitoring of well-being and heart rate (HR) of a pregnant woman, with the appointment of an individual training load of heart rate (HR) during the lesson and its gradual increase. At the same time, heart rate is determined as the difference between training heart rate and resting heart rate and compared with the optimal values of load heart rate at each stage of the training cycle. The optimal value of HR at the first stage of the training cycle is HR = 6, at the second stage HR = 7, at the third stage HR = 8. In addition, the known method provides for double control at the beginning and at the end of the session of blood pressure (BP) and correction training programs through individual selection of special exercises.

The disadvantage of the known method, adopted as a prototype [11], is the limited controllable parameters, as indicators of a pregnant woman's well-being used to prevent preeclampsia, at the date of establishing the fact of her pregnancy, which potentially increases the possible risks of the onset and development of preeclampsia due to not taking into account the entire complex of manifestations symptoms of preeclampsia during the control of the state of the pregnant woman on the date of her admission to classes.

The claimed invention is free from these disadvantages and its technical result is to improve the accuracy and efficiency of detecting preeclampsia at the earliest stages of its manifestation by involving the entire complex of controlled indicators of the health status of a pregnant woman, at the fixed date of establishing her pregnancy in order to reduce her possible risks of occurrence and development of preeclampsia.

The technical result of the claimed invention consists in reducing the detection time and earlier detection of the risk group for the manifestation of preeclampsia and increasing the level of its prevention in pregnant women by expanding the controlled parameters of the pregnant woman's well-being and identifying predictor markers as danger indicators, which, if they are not taken into account in a timely manner, can lead to further progressive development of preeclampsia.

For the optimal implementation of the specified technical result in the claimed invention, risk groups are determined, taking into account the controlled parameters of the pregnant woman's well-being, which are formed according to the complex values of the degree of manifestation of predictor markers. Individually, for each pregnant woman from the corresponding risk group, an optimal, individual training cycle of classes is prescribed under the control of predictor markers that precede the onset of symptoms of preeclampsia, which include gestational weight, outwardly pronounced edema, an increase in systolic and diastolic pressure relative to the norm, and decreased pulse pressure.

The specified technical result is achieved by the fact that in the known method of identifying the prerequisites for the appearance of preeclampsia in pregnant women and their timely prevention by means of aqua fitness, which consists in prescribing a training cycle, consisting of three stages of regular 8-12 training sessions in water, lasting 50-60 minutes, carried out at least 2 times a week, starting from the second trimester of pregnancy, while three parts of the training session include 40-50 exercises combined into at least 5-8 blocks, including a distance swimming block that the pregnant woman swims at each lesson with constant monitoring of her well-being and heart rate by pulse, after each swimming exercise, which corresponds to the individual aerobic load regimen assigned to the pregnant woman, while with at least two control for one lesson of blood pressure, in accordance with the claimed invention, previously , prior to the start of classes and the appointment of an individual training cycle of classes for a pregnant woman, a comprehensive monitoring of her well-being is carried out, as an indicator of which predictor markers are used with the values of the main medical indicators preceding the onset of symptoms of preeclampsia, including, at a minimum, gestational weight, outwardly pronounced edema, increased relative to the norm, systolic and diastolic pressure, low pulse blood pressure, after which pregnant women, without pronounced pathology and body mass index (BMI) from the fact of establishing the onset of pregnancy in the range of 18.5-24.9 kg / m ² , starting from the second trimester pregnancies are combined into three risk groups, each of which is formed according to the complex values of the degree of manifestation of predictor markers taken as indicators of the risk of developing preeclampsia, while:

- the first group includes pregnant women with minimal deviations from the norm, in which the weekly gestational weight gain is in the range of 300-450 g per week, the value of systolic blood pressure at the time of the start of classes is not more than 120 mm Hg. Art., diastolic blood pressure not more than 80 mm Hg. Art., pulse arterial pressure not less than 30 mm Hg. Art., swelling of the hands and feet appear slightly in the second half of the day, and pregnant women of the first group are prescribed aqua fitness classes lasting 50 minutes each with a regularity of 1-2 times a week,

- the second group includes pregnant women whose weekly gestational weight gain is in the range of 451-800 g, the value of systolic blood pressure is not more than 130 mm Hg. Art., diastolic blood pressure not more than 85 mm Hg. Art., pulse arterial pressure not less than 25 mm Hg. Art., swelling of the hands and feet appear in the morning, immediately after waking up, and pregnant women of the second group are prescribed aqua fitness classes lasting 60 minutes each with a regularity of at least 2 times a week,

- the third group includes pregnant women whose weekly gestational weight gain is more than 800 g per week for 2 weeks in a row, the value of systolic blood pressure is not more than 140 mm Hg. Art., diastolic blood pressure not more than 90 mm Hg. Art., pulse blood pressure of at least 20 mm Hg. Art. and not more than 60 mm Hg. Art., with the visual presence of swelling of the face and / or abdomen, pregnant women of the third group conduct aqua fitness classes under the direct supervision of an obstetrician-gynecologist at a dosage of at least 3 times a week, lasting 60 minutes each, with a maximum value of heart rate load not more than 3 -X.

In addition, this technical result is achieved by the fact that, in addition to the three main groups, a special group is distinguished and in the presence of risk factors for preeclampsia, which include overweight before pregnancy, with a body mass index of more than 24.9 kg/m ² , the age of a pregnant woman over 35 years old, the presence of hypertension, aqua fitness classes are prescribed with a regularity of 1-2 times a week, lasting at least 45 minutes each and the maximum value of the heart rate of the load is not more than 3, starting from the 14th week of pregnancy, under constant supervision of an obstetrician-gynecologist.

The claimed invention was tested in real time from September 2018 to February 2020 with the participation of at least 350 pregnant women (St. Petersburg) under the constant supervision and control of swimming trainers together with obstetrician-gynecologists (hereinafter control group), which as sensitive indicators were taken to be minimal changes-deviations in individual indicators of the main predictor markers. These, first of all, included: changes in gestational weight in the first, second and third trimesters of pregnancy, changes in systolic, diastolic and pulse blood pressure, the presence of externally visualized edema. The results of testing showed the reliability and effectiveness of the proposed method.

The implementation of the claimed method is carried out as follows: after obtaining admission to classes in the pool, the pregnant woman, taking into account her individual indicators and under the supervision of the instructor, performs a special set of exercises in the sequence and volume specified by the instructor.

Before starting classes, they are given an introductory briefing, anamnesis and visual control, receive individual information about the health status of each student, including the characteristics of the course of pregnancy to analyze and predict potential risks of abortion and/or premature birth. When the instructor prescribes appropriate dosed loads, taking into account the systemic survey of the pregnant woman about her well-being and the mandatory recording of her personal parametric indicators in the individual card of the pregnant woman, which, first of all, include age, weight, height, blood pressure from the fact of establishing the onset of pregnancy, note the presence externally visualized edema and, using weight and height indicators, determine the initial body mass index (BMI), kg/m ² . In addition, gestational weight gain is recorded at the time of the start of classes and further gestational weight gain is recorded at least once every two weeks. Pregnant women with a BMI in the range of 18.5–24.9 kg/m ² are divided into three risk groups, depending on the severity of the recorded indicators, predictive markers of preeclampsia (table 1). Pregnant women with a BMI over 24.9 kg / m ² are assigned to a special group. If at least one of the listed indicators is in an increased risk group, then the pregnant woman begins classes according to the recommendations given for this group. With changes in the recorded indicators, during the cycle of training sessions, the pregnant woman is transferred to another risk group corresponding to her new indicators.

Table 1

Preeclampsia symptom markers and

distribution of pregnant women by risk groups

Indicators
(predictor markers) First group
(1-2 r / week,
50 min.) Second group
(2 r / week,
60 min) Third group
(3 r / week,
60 min) SBP (mm Hg) < 120 < 130 < 140 DBP (mm Hg) < 80 < 85 < 90 PAD (mm Hg) > 30 > 25 > 20 Weight, g/week 300-450 451-800 > 800 Edema Hands and feet
By the evening Hands and feet
in the morning Face and/or abdomen

Pregnant women, whose weekly gestational weight gain, starting from the second trimester and at the time of the start of classes, is in the range of 300-450 g, are classified as the first risk group and they are recommended to do aqua fitness classes with a regularity of 1-2 times a week lasting 50 minutes each. The second risk group includes pregnant women whose weekly gestational weight gain is in the range of 451–800 g and they are recommended to attend classes with a regularity of at least 2 times a week and lasting 60 minutes each. The third risk group includes pregnant women whose weekly gestational weight gain was more than 800 g for 2 weeks in a row and they are prescribed aqua fitness classes at least 3 times a week, lasting 60 minutes each.

Before and after the end of each session, pregnant women are measured for blood pressure, in a sitting position and after 5 minutes of rest, using an automatic tonometer, in accordance with the rules for measuring blood pressure and, according to the totality of fixed indicators, they are assigned to the appropriate risk group.

With indicators of systolic blood pressure (SBP) not more than 120 mm Hg. Art., diastolic blood pressure (DBP) not more than 80 mm Hg. Art., pulse blood pressure (PAD) more than 30 mm Hg. Art., a pregnant woman is identified in the first risk group and is recommended to attend classes with a regularity of 1-2 times a week and a duration of 50 minutes each, according to the individual aerobic exercise regimen recommended for healthy pregnant women, without restrictions.

With indicators of SBP not more than 130 mm Hg. Art., DBP not more than 85 mm Hg. Art., PAD not less than 25 mm Hg. Art., a pregnant woman is recommended to attend classes with a regularity of at least 2 times a week and a total duration of at least 60 minutes. At the same time, the pregnant woman is additionally recommended to independently measure blood pressure at home, at least 2 times a day (in the morning after breakfast and in the evening, before going to bed), and be under the supervision of the antenatal clinic leading her pregnancy.

With indicators of SBP not more than 140 mm Hg. Art., DBP not more than 90 mm Hg. Art., PAD not less than 20 and not more than 60 mm. rt. Art. a pregnant woman is recommended to attend classes at least 2-3 times a week, lasting 60 minutes each and the maximum value of the heart rate of the load is not more than 3. At the same time, a pregnant woman is recommended to independently measure blood pressure at home, at least 3 times a day (in the morning after breakfast, in the afternoon and evening, before bedtime). With single-registered SBP values equal to or exceeding 140 mm Hg. Art., DBP 90 mm Hg. Art., PAD equal to and below 20 mm Hg. Art. pregnant women are advised to seek routine medical care. When registering these indicators for three measurements in a row (for example, in the evening, in the morning of the next day and in the afternoon), the pregnant woman is recommended to seek emergency medical care to determine (approve) the tactics of pregnancy management and, if necessary, medical correction of her condition.

Before the start of each lesson, a visual control is carried out for the presence of visible edema in the pregnant woman. When the first signs appear, such as swelling of the hands “ring syndrome” and feet, by the evening, which, as a rule, disappear by morning, the pregnant woman is prescribed aqua fitness classes, at least 1-2 times a week, 50 minutes each. When observing edema in the morning, a pregnant woman is recommended to increase the number and duration of aqua fitness at a dosage of at least 2 times a week and a total duration of at least 60 minutes each. When visualizing edema of the face and / or abdomen in a pregnant woman, classes are prescribed with a regularity of at least 2-3 times a week and a total duration of at least 60 minutes each. At the same time, the pregnant woman is additionally weighed before and after the lesson, and also pay attention to the positive daily diuresis.

The results of approbation of the claimed method for identifying the prerequisites for the appearance of preeclampsia in pregnant women and their timely prevention by means of aqua fitness are given below in the form of specific examples of implementation.

Example 1

Trained Anna V., 33 years old, 1st birth, began to exercise in the pool from the 16th week of pregnancy, on the recommendation of a cardiologist, 1-2 times a week, according to the proposed program from the 23rd week, 2-3 times a week. She was under the supervision of a cardiologist from the 14th week of pregnancy, at this time the first excess of her regular blood pressure was detected. Prior to pregnancy, there were no complaints of high blood pressure. Pregravid body mass index (BMI) was 22.1 kg/m². Gestational weight gain in the first trimester was 1.5 kg, in the second trimester it did not exceed 450 g per week (5.3 kg), and 350 g in the third trimester (3.8 kg). In total, for the entire pregnancy, body weight increased by 10.6 kg. According to the totality of signs at the time of the start of classes (observation by a cardiologist, an increase in systolic blood pressure above 130 mm Hg), the pregnant woman was identified in the third risk group and was engaged in the program 2–3 times a week, with a maximum value of heart rate load not more than 3 -X. It was recommended to self-monitor blood pressure at home, in the morning after breakfast and in the evening before bed.

As a result of regular classes according to the proposed program, the pregnant woman felt good, improved blood pressure after class. Together with an obstetrician-gynecologist, at a period of 28 weeks, it was decided to increase the load and transfer the pregnant woman to the second risk group and assign her a load heart rate value in the range of 6–8, while she was performing distance swimming exercises.

This pregnancy, in addition to episodic increase in blood pressure, proceeded without complications. Regular classes, according to the proposed pregnant program, made it possible to maintain normal blood pressure indicators, almost throughout the entire pregnancy. The maximum increase in blood pressure, up to 160/110 mm Hg. Art., for a period of 36 weeks, was recorded by the pregnant woman on her own at home, after which the pregnant woman applied for planned medical care and she was prescribed antihypertensive drugs, without canceling the prescribed aqua fitness classes, but with a decrease in the heart rate value of the load to 3. From the 38th week, protein was detected in urine tests, up to 2 g / l. Despite the fact that the first increase in blood pressure was detected in a woman practicing at the beginning of pregnancy, with a diagnosis of moderate preeclampsia at the antenatal department, the pregnant woman was hospitalized only for a period of 39 weeks, and antihypertensive drugs were started only from the 36th week of pregnancy, which made it possible to significantly reduce drug load on the expectant mother and child.

The pregnancy ended with induced (according to mother's indications) natural childbirth of a healthy baby. Boy 2930, 50 cm, 8/9 Apgar. Individual indicators of blood pressure before and after exercise, changes in body weight and the presence of edema during pregnancy, recorded in the period from the 23rd to the 38th week of pregnancy are presented in Table 2.

table 2

Blood pressure before and after exercise, changes in body weight and

edema during pregnancy

Indicators/
number of weeks
pregnancy increase
weight,
kg Edema BP (before class) BP (after class) SD DD PD SD DD PD 23 5.5 - 133 78 55 125 86 39 24 5.9 - 109 74 35 118 78 40 28 7.3 - 136 93 43 112 86 26 35 9.4 - 127 91 36 122 86 36 36 9.7 - 133 92 41 123 92 31 37 10.0 - 126 93 33 121 89 33 38.5 10.2 - 150 102 48 148 109 39

Example 2

Trained Anastasia M., 42 years old, 1st birth. I started exercising from the 30th week of pregnancy. I attended classes in the pool regularly, 2 times a week. BMI at the start of pregnancy - 29.1 kg / m ² . Normal blood pressure before pregnancy 110/70 mm Hg. Art. Pregnancy occurred as a result of IVF, the pregnant woman suffers from varicose veins. The first increase in blood pressure to 135/85 mm Hg. Art. observed at 26 weeks. Until the 20th week of pregnancy, it was recommended to limit any physical activity. The total weight gain during pregnancy was 20 kg, while at the time of the start of classes, for a period of 30 weeks, the total gestational weight gain was 16 kg. Weight gain in the first trimester was 5-6 kg, in the second - 7-8 kg, while at the 24th week there was a sharp jump in weight to 4.2 kg in two weeks. In the third trimester, weight gain was 5–6 kg, while the figures did not go beyond 300–450 g per week. Taking into account the anamnesis and background conditions (age 42 years and excess body weight before pregnancy), the pregnant woman was assigned to a special group. Individual indicators of blood pressure before and after exercise, changes in body weight and the presence of edema during pregnancy, recorded in the period from the 30th to the 36th week of pregnancy are presented in Table 3.

Table 3

Blood pressure before and after exercise, changes in body weight and

edema during pregnancy

Indicators/
number of weeks
pregnancy increase
weight,
kg Edema BP (before class) BP (after class) SD DD PD SD DD PD thirty 16.0 feet 121 86 35 109 79 thirty 31 16.0 112
122 81
84 31
38 104
120 83
84 21
36 36 17.8 shins 132 82 50 124 85 39

At the time of the start of classes, swelling of the hands and feet was visually observed, and starting from the 35th week, according to the pregnant woman, with an interval between classes of more than three days, her face swelled and blood pressure increased irregularly to 150/90 mm. rt. Art. However, the diagnosis of preeclampsia was not made. According to the practitioner, the weight before and after the session decreased by an average of 0.8–1 kg. A positive daily diuresis was observed, the amount of liquid excreted was 1000 ml more than that drunk. For a period of 36 weeks, during the exercises of the distance swimming block, the values of the heart rate of the load were constantly recorded, which by the beginning of the next exercise was equal to 4. Despite the good health and comfortable feelings of the pregnant woman, the control group for the condition of the pregnant woman was recommended to increase the rest intervals between exercises . The pregnancy ended with a planned caesarean section at 39 weeks and the birth of a healthy boy 3880 g., 50 cm.

Example 3

Caring Karina S., 28 years old, 1st birth. Classes attended with regularity 1-2 times a week. Until the 14th week there was a threat of termination of pregnancy. Among the background conditions were observed hypertension, varicose veins, pyelonephritis. Admission to classes from the doctor received from the 21st week. Pregravid BMI - 22.4 kg / m ² . Weight gain for the entire pregnancy was 11 kg, with the largest increase in body weight observed in the first trimester. Due to weekly weight gain, by the time the classes began, by more than 450 g per week, the pregnant woman was identified in the second risk group and received recommendations to exercise at least 2 times a week, however, due to work and family circumstances, the pregnant woman could not attend classes more than 1-2 times a week.

By conducting regular classes according to the recommended program, during the second and third trimester, the pregnant woman was able to stop the rapidly progressive, excess weight gain and reduce it to values equal to 300-450 g per week, while the state of health of the pregnant woman was noted as good, and sensations during exercise as comfortable. The first increase in DD (diastolic pressure) and low PP (pulse pressure) before the start of the lesson in a pregnant woman was recorded before the start of the lesson for a period of 27 weeks, after the lesson these indicators returned to normal and, according to the pregnant woman, her health improved significantly. The pregnant woman was recommended to continue performing tasks under the program of the third risk group. Namely, increase the number of visits to 2–3 per week, begin to independently monitor blood pressure at least twice a day, seek planned medical care. On consultation with the doctor, no complications of the course of pregnancy were revealed, the pregnant woman was recommended to lead her normal life, without any additional prescriptions.

Starting from the 30th week, swelling of the hands began to appear in the pregnant woman in the evening, then swelling of the ankles and legs joined, which by the end of the 32nd week were noted in the morning, immediately after waking up, and by the 35th week facial edema was visualized. During the lessons, the pregnant woman went to the toilet at least 2 times, while her weight before and after the lesson differed by 500–700 g, and daily positive diuresis was observed. At week 33, during self-monitoring of blood pressure at home, indicators of 135/90 mm Hg were recorded. Art., after which for the correction of blood pressure, the pregnant woman was prescribed antihypertensive drugs. At the 35th week, the pregnant woman was hospitalized due to an increase in protein in the urine up to 3 g/l. According to the pregnant woman in the hospital, blood pressure was at the level of 145/95 mm Hg. Art.

The pregnancy ended in induced labor (according to the mother's testimony), which ended in an emergency caesarean section at 36.6 weeks. Boy 2880, 49 cm, Apgar score 8/9. Individual indicators of blood pressure before and after exercise, changes in body weight and the presence of edema during pregnancy, recorded in the period from the 22nd to the 35th week of pregnancy are presented in Table 4.

Table 4

Blood pressure before and after exercise, changes in body weight and

edema during pregnancy

Indicators/
number of weeks
pregnancy increase
weight,
kg Edema BP (before class) BP (after class) SD DD PD SD DD PD 22 6.9 - 120 79 41 118 77 41 26 7.5 - 124 86 38 127 89 38 27 7.8 - 120
120 105
98 15
22 120 84 36 thirty 8.7 brushes 109 77 32 113 77 36 31 9.1 feet 116 82 34 118 82 36 32 9.4 shin 129 80 49 124 84 40 35 10.3 face 118 77 41 125 85 40

Example 4

Exercising Christina I., 32 years old, 1st birth, started exercising in the pool from the 21st week of pregnancy, 1-2 times a week. Pregravid BMI was 23.8 kg/m ² . Gestational weight gain in the first trimester was 3-4 kg, in the second trimester 9 kg, while the weekly weight gain in the range of 451-800 g was maintained until the 30th week. In the third trimester, it was possible to stop the rapid weight gain of the pregnant woman. In total, for the entire pregnancy, the body weight of the pregnant woman increased by 17 kg. According to the totality of signs at the time of the start of classes, the pregnant woman was assigned to the second risk group and was engaged in the program recommended for this group, with load heart rate values in the range of 6–8. This pregnancy, in addition to an episodic decrease in pulse arterial pressure, proceeded without complications. At the 33rd week, an underestimated PBP of 28 mm Hg was recorded. Art. before the start of the session, but after the session, the PAD returned to normal.

Regular classes, according to the recommended pregnant program, made it possible to maintain normal blood pressure indicators, almost throughout the entire pregnancy. At the 36th week of pregnancy, swelling of the hands and feet was recorded. A sharp decrease in PAP to 15 mm Hg. Art. was recorded at a period of 41 weeks before the start of the lesson, the pregnant woman was admitted to classes, but with recommendations to limit the heart rate of the load to no more than 3. After the session, the blood pressure indicators returned to normal, the state of health improved, while the PBP indicators increased to 37 mm Hg. mm. At the period of 40 weeks, a sharp jump in weight gain was recorded, 900 grams in 1 week, the pregnant woman was recommended to continue at least 2-fold daily monitoring of blood pressure indicators, record the amount of fluid drunk and excreted and seek planned medical care from a doctor obstetrician-gynecologist leading pregnancy. According to the results of the examination, no additional medical correction of the state of health of the pregnant woman was required. The pregnant woman continued to practice in the water almost until the birth.

The pregnancy ended in natural delivery at term (41 weeks and 5 days) with a healthy girl, 3380 g, 52 cm, 8/9 Apgar scores. Individual indicators of blood pressure before and after exercise, changes in body weight and the presence of edema during pregnancy, recorded in the period from the 25th to the 41st week of pregnancy, are presented in Table 5.

Table 5

Blood pressure before and after exercise, changes in body weight and

edema during pregnancy

Indicators/
number of weeks
pregnancy increase
weight, kg Edema BP (before class) BP (after class) SD DD PD SD DD PD 25 10.0 - 117 82 35 113 76 37 thirty 13.9 - 102 70 32 110 74 36 33 14.0 - 98 70 28 108 74 34 36 14.0 brushes,
feet and shins 112 72 40 111 78 33 38 14.0 100 74 26 108 74 34 40 14.9 108 78 thirty 108 76 32 41 15.7 101 86 15 107 70 37 41.3 16.5 114 85 29 109 77 32

Example 5

Exercising Irina I., 28 years old, 1st birth, started exercising from the 18th week of pregnancy. I attended classes 1-2 times a week. Pregravid BMI - 19.4 kg / m ² . Normal BP 100/70 mm Hg. Art. The pregnancy proceeded without complications. During pregnancy, the total weight gain was 11 kg. In the first trimester, weight gain was zero, in the second and third trimesters, weight gain was 5 and 6 kg, respectively, with weekly rates in the range of 300–450 g.

The trainee attended classes regularly, according to the program of the first risk group, intended for pregnant women with minimal deviations in the state of health, while her good health was noted, which was confirmed by a comfortable state and objective and subjective methods of control. From the 36th week, the first decrease in PBP to 25 mm Hg was recorded. Art., in the same period, edema of the hands and feet began to appear in the evening, and from the 38th week, edema of the hands (“ring syndrome”) was observed in the morning, immediately after waking up.

The pregnancy ended in natural childbirth, on time (40 weeks and 2 days) with a healthy girl, 3430 g, 53 cm, 8/9 Apgar scores. Individual indicators of blood pressure before and after exercise, changes in body weight and the presence of edema during pregnancy, recorded in the period from the 18th to the 39th week of pregnancy are presented in Table 6.

Table 6

Blood pressure before and after exercise, changes in body weight and

edema during pregnancy

Indicators/
number of weeks
pregnancy increase
weight, kg Edema BP (before class) BP (after class) SD DD PD SD DD PD 18 2.5 - 105 70 35 108 79 29 20 3.1 - 107 77 thirty 108 76 32 22 3.8 - 112 73 39 101 70 31 26 5.0 - 111 69 42 112 71 41 thirty 6.8 112 74 38 108 75 33 36 9.4 brushes,
feet and shins 104 79 25 111 81 thirty 39 10.3 114 85 29 109 77 32

In addition to examples 1-5, which illustrate the effectiveness of the claimed method, the following are additional test results confirming the effectiveness of the proposed method for the prevention of preeclampsia.

To assess the health-improving impact of a cycle of classes according to the proposed method, comparisons were made of the results of a comprehensive medical and pedagogical control of pregnant women who attended and did not attend classes during pregnancy. As a result, a control group and a comparison group were created. The control group included 193 pregnant women who attended aqua fitness classes according to the claimed method, the comparison group consisted of 178 pregnant women who did not attend such classes. The studies were carried out on the basis of the network of pools "Atlantika" (St. Petersburg), on the street. Bucharestskaya) and maternity hospital No. 6 named after prof. V. F. Snegirev (St. Petersburg). The studied groups were formed homogeneous and comparable in age, weight and height indicators, as well as somatic and obstetric-gynecological anamnesis. Table 7 presents a comparative analysis of the data on the development of preeclampsia and the percentage of the incidence of preterm birth in the study groups.

Table 7

The development of preeclampsia and the frequency of preterm birth

Indicators, (%) Control group
(n=193) Comparison group
(n=178) Reliability of results Preeclampsia severe
degrees and eclampsia 2.6% 12.9% p<0.01 Moderate Preeclampsia 11.4% 25.2% p<0.05 Early manifestation of preeclampsia
(up to 34 weeks) 1.0% 16.2% p<0.05 Late onset preeclampsia 12.97% 21.9% p<0.05 preterm birth
(until week 37) 0.51% 10.1% p<0.01

In the group of pregnant women who attended aqua fitness classes in accordance with the proposed method, severe preeclampsia and eclampsia were significantly less common and 2.6%, the frequency of this complication in the comparison group developed in 12.9% of cases. The incidence of moderate preeclampsia in the control group was 11.4%, in the comparison group this figure was more than twice as high and was at the level of 25.2%. At the same time, early manifestation of preeclampsia, up to 34 weeks, in the control group was observed in 1.0% of cases, in the comparison group this figure was 16.2%. Most often, the development of such a complication was observed at later stages of pregnancy, and in the control group it occurred in 12.97% of cases, and in the comparison group in 21.9% of cases. The reason for premature birth in the study groups was the need for early termination of pregnancy for health reasons on the part of the mother and was due to the development of preeclampsia in the control group, preeclampsia and eclampsia in the comparison group. In the control group, the frequency of preterm birth was 0.51%, in the comparison group - 10.1%. Indicators of physiological maturity of newborns are presented in table 8.

Table 8

Physiological maturity of newborns

Indicators Control group
(n=193) Comparison group
(n=178) Reliability of results Newborn Apgar score
(points) for 1 min 7.96 7.38 p<0.01 after 5 minutes 8.82 7.84 p<0.01 Child height (cm) 52.0 50.8 p<0.01 Child weight (grams) 3463.7 3276.3 p<0.05

When comparing perinatal outcomes in both groups, it was found that the weight of newborn babies in the control group was 3.463.7 g, in the comparison group 3.276.3 g. The growth of children at birth also differed significantly - 52.0 cm in the control group and 50 .8 see in the comparison group. Newborns were assessed on the Apgar scale immediately after birth and 5 minutes after birth. Infants whose mothers were engaged in aqua fitness during pregnancy according to the proposed method received scores of 7.96 and 8.82 points. The children of those mothers who were in the comparison group and did not attend classes received 7.38 and 7.84 points. Comparison of the results of gestational weight gain and the presence of edema in pregnant women in the study groups are presented in Table 9.

Table 9

Gestational weight gain and edema

Indicators Control group
(n=193) Comparison group
(n=178) Reliability of results Edema, % 58.5 83.7 p<0.01 Gestational weight gain, kg 12.24 14.1 p<0.05

The incidence of edema in pregnant women of the control group was 58.5%, in women of the comparison group - 83.7%. The average gestational weight gain in women in the control group was 12.24 kg; in pregnant women in the comparison group, the total gestational weight gain was 14.1 kg.

In the analysis of the matrix, paired Pearson correlation coefficients, including 102 studied parameters, significant differences were found between the timing of the onset of edema and the total weight gain during pregnancy, in the value of 0.424 at a significance level of p<0.012, where p is the significance of the significance of the results.

A close relationship in terms of Pearson's correlation indicators at a value of 0.689 at a significance level of p<0.0001 was found between the timing of the first increase in blood pressure and subsequent hospitalization of a pregnant woman with edema in a day hospital. In the study groups, as the examples show, a relationship was found between the timing of the first increase in blood pressure and the amount of protein (g/l) determined in urine tests, in the value of 0.487 at a significance level of p<0.001.

The results of numerous studies conducted by the applicants, to assess the impact of the claimed method on the health status of a pregnant woman during aqua fitness, clearly illustrate the presence of pronounced preclinical precursors of preeclampsia symptoms, identified using predictor markers, to which the applicants-authors include gestational weight, visually determined edema and blood pressure.

In pregnant women with an uncomplicated anamnesis and normal BMI, the appearance of predictor markers has its own sequence, namely negative or rapidly progressive, excess weight gain (more than 800 g per week) during the first trimester. Also a harbinger is a rapidly progressive weight gain in the second trimester of pregnancy, with rates of more than 800 g in one week. Then there are minor edema, such as "ring syndrome" and swelling of the feet, passing by the morning. Most often this occurs between the 30th and 35th weeks of pregnancy. Leaving aside weight gain and minor edema, the next step will be visualized edema in the morning, immediately after waking up, and starting from the 36th week, facial edema and / or the first increase in systolic blood pressure can already be expected.

A predictive marker of preeclampsia at any stage of pregnancy is a decrease in pulse arterial pressure to less than 30 mm. rt. Art.

As the results of studies have shown, the timely impact of aquafitness means on the predictor markers identified at an early stage, as on separate links in the general chain of symptoms and keeping them under control, will prevent and/or significantly slow down the devastating effects of preeclampsia and its consequences on the mother and child. . This, in turn, will significantly reduce the significant drug burden on the mother and unborn child, while maintaining their health, and will also reduce the social burden on government programs financed from the state budget with significant costs for inpatient treatment of preeclampsia due to the preventive effect on predictor markers pre-eclampsia with simple, affordable and safe aqua fitness.

Information sources used

1. RF patent No. 2682167 (IPC: A61K 31/505; A61K 31/57; A61P 5/06) for the invention "Method for the prevention of preeclampsia".

2. Patent of the Russian Federation No. 2663593 (IPC: A61K 31/455; A61P 15/06) for the invention "Method for the prevention of preeclampsia in patients with a burdened obstetric history."

3. Patent of the Russian Federation No. 2697845 (IPC: G01N 33/49) for the invention "Prediction of preeclampsia based on the determination of fetal extracellular DNA in maternal blood during screening of the first trimester of pregnancy."

4. RF patent No. 2693412 (IPC: G01N 33/53) for the invention "Method for predicting early and late preeclampsia."

5. RF patent No. 2699974 (IPC: C12Q 1/686; A61B 5/021) for the invention "Method for predicting the risk of developing preeclampsia in women with chronic arterial hypertension."

6. McDonell V.A. The role of prognostic markers for early diagnosis of preeclampsia / V.A. McDonell // Global problems of our time. - 2021. - T. 2. - No. 1. S. 18–38.

7. Wolf Yu. Clinical and genetic markers for predicting and diagnosing early and late preeclampsia: author. dis. … cand. honey. sciences / Wolf Julia. - Moscow, 2019. - 24 p.

8. Mutsalkhanova Yu.S. Pre-eclampsia prediction in early pregnancy: author. dis. … cand. honey. Sciences / Mutsalkhanova Yulduz Sultanovna. - Rostov-on-Don, 2018. - 28 p.

9. Khlestova G. V. Prediction and early diagnosis of preeclampsia based on the assessment of the renin-angiotensin and vasopressin-aquaporin systems: author. dis. … cand. honey. Sciences / Khlestova Galina Vladimirovna. - Moscow, 2018. - 34 p.

10. Sadretdinova T. L. Prevention of preeclampsia with the use of physical exercises in water in the form of water aerobics: author. dis. … cand. honey. Sciences / Sadretdinova Tatyana Leonidovna. - Pyatigorsk, 2014. - 26 p.

11. Patent of the Russian Federation No. 2724861 (IPC: A61N 33/00; A63V 22/00) for the invention "Method for preventing preeclampsia in pregnant women by means of aqua fitness" (prototype).

Claims (4)

A method for identifying the prerequisites for the appearance of preeclampsia in pregnant women and their timely prevention by means of aqua fitness, including a training cycle consisting of three stages of regular training sessions in water lasting 50-60 minutes, starting from the second trimester of pregnancy, while three parts of the training session include 40- 50 exercises combined into at least 5-8 blocks, including a distance swimming block, which a pregnant woman swims at each lesson while monitoring her well-being by heart rate and at least twice monitoring blood pressure in one lesson, characterized in that beforehand, before carrying out an individual training complex of classes with a pregnant woman, additional monitoring of the state of health of a pregnant woman is carried out, where markers-predictors are used as an indicator with the values of the main medical indicators preceding the onset of symptoms of preeclampsia, including, at a minimum, gestational weight, outwardly pronounced edema, increased relative to the norm systolic and diastolic blood pressure, low pulse blood pressure, after which pregnant women are selected without a pronounced pathology and a body mass index from the fact of establishing the onset of pregnancy in the range of 18.5-24.9 kg / m ² and distribute them into the following three risk groups, each of which are formed according to the complex values of the degree of manifestation of predictor markers, taken as indicators of the danger of developing preeclampsia, while - the first group includes pregnant women with minimal deviations from the norm, in which the weekly gestational weight gain is 300-450 g, the value of systolic blood pressure at the time of the start of classes is not more than 120 mm Hg. Art., diastolic blood pressure not more than 80 mm Hg. Art., pulse arterial pressure not less than 30 mm Hg. Art., and swelling of the hands and feet is visually observed in the second half of the day, and with pregnant women of this group they conduct training sessions in the water at least 1 time per week, lasting 50 minutes each, - the second group includes pregnant women whose weekly gestational weight gain is 451-800 g, the value of systolic blood pressure is in the range of 121-130 mm Hg. Art., diastolic blood pressure 81-85 mm Hg. Art., pulse blood pressure 25-29 mm Hg. Art., and swelling of the hands and feet is visually observed in the morning, immediately after waking up, and with pregnant women of this group, training sessions are carried out in water with a regularity of at least 2 times a week, lasting 60 minutes each, - the third group includes pregnant women whose weekly gestational weight gain is more than 800 g for 2 weeks in a row, the value of systolic blood pressure is in the range of 131-140 mm Hg. Art., diastolic blood pressure 86-90 mm Hg. Art., pulse blood pressure 20-24 mm Hg. Art., with the visual presence of swelling of the face and / or abdomen, while training sessions in the water are carried out at least 3 times a week, lasting 60 minutes each.