Prevention and treatment of complications in pregnant women with chronic diseases

ABSTRACT

Objective. The aim of the study was to evaluate the effectiveness of a multidisciplinary approach in reducing obstetric and neonatal complications in pregnant women with chronic diseases compared with standard management.

Materials and Methods. The prospective cohort study, conducted at Kyiv City Clinical Hospital No. 5 from January 2023 to December 2024, analysed data from 150 patients in the intervention group (integrated strategy involving a cardiologist, endocrinologist, and nutritionist) and 150 patients in the control group (standard care).

Results. Significant reduction in the incidence of pre-eclampsia in the intervention group (12% vs 37%; relative risk 0.32; p = 0.001), preterm birth (14% vs 32%; p = 0.003), and gestational diabetes requiring insulin (8% vs 22%; p = 0.01). The mean time of pre-eclampsia debut in the intervention group was 32.5 ± 2.1 weeks versus 28.4 ± 3.5 weeks in the control group (p = 0.02). Neonatal outcomes demonstrated a higher average birth weight (3200 ± 450 g vs 2900 ± 500 g; p = 0.002), lower incidence of respiratory distress syndrome (4% vs 15%; p = 0.01) and hypoglycaemia (7% vs 20%; p = 0.01). The control of chronic diseases (hypertension, diabetes, autoimmune thyroiditis) in the intervention group was more effective: 89% of patients achieved the target blood pressure (≤ 135/85 mm Hg) vs 65% in the control group (p = 0.01), and 91% achieved the target thyroid hormone level (0.5-2.5 mIU/l) vs 60% (p = 0.002).

Conclusions. The findings confirm that a multidisciplinary approach reduces complications through individualised protocols, early monitoring, and non-pharmacological methods. These can be integrated into clinical guidelines to improve perinatal outcomes in high-risk groups, with adaptations for local resources and sociocultural factors.

Key words

Gestational diabetes mellitus; arterial hypertension; multidisciplinary approach; neonatal indicators; pre-eclampsia.