Clinical manifestations and hemostasis in pregnant women with arterial hypertension and obesity

Background. Clinical manifestations, remodeling of the cardiovascular system and changes in the hemostasis system in pregnant women with different body mass index (BMI) in combination with chronic arterial hypertension (CHTN) are of significant clinical interest. Obesity in pregnant women is one of the most significant causes of complications in both mother and fetus. Additional diagnostic criteria for cardiac remodeling in pregnant women with CHTN in combination with different BMI, as well as hemostasis indicators characterized by the tendency to hypercoagulation, have been identified. Objective. To identify the most significant diagnostic and differentialdiagnostic criteria of hemostasis indicators, as well as cardiovascular system remodeling, in pregnant women with CHTN combined with obesity, overweight, and normal body weight, during different periods of pregnancy. Design and methods. The study was conducted to assess the clinical condition of pregnant women with CHTN and various BMI throughout the gestation period. We analyzed a total of 2,244 individual cards of pregnant and postpartum women of the antenatal clinic (2021 — 584, 2022 — 612, 2023 — 546, 2024 — 502), and selected cards of patients (120 in total) with CHTN. In addition, we analyzed 120 outpatient records from the clinical and diagnostic department, where the patients were followed by a cardiologist. All the women were of European descent and were of young age (according to the WHO classification), ranging from 19 to 43 years old (mean age of 33 ± 1,28 years). The distribution of the groups was based on the classification of BMI. The first group (n = 68) included pregnant women with CHTN and obesity (BMI ≥ 30 kg/m2), the second group (n = 24) included pregnant women with CHTN and overweight (BMI = 25–29,9 kg/m2), and the third group (n = 28) included pregnant women with CHTN and normal weight (BMI = 18,5–24,9 kg/m2). BMI was assessed at the patient's first visit to the maternity hospital consultation (in the first trimester of pregnancy). In all women, we assessed clinical factors, laboratory and diagnostic tests, and the structural and functional state of the heart. Results. In the group of pregnant women with verified CHTN and obesity, the size of the left atrium is significantly larger than in the groups of women with CHTN and overweight or normal body weight. Additionally, pregnant women with CHTN and obesity have specific features of the hemostasis system, such as an increase in the number of platelets throughout gestation. Dynamic monitoring of hemostasis indicators showed a tendency towards an increase in the level of soluble fibrin monomer complexes (SFMC), indicating an increased tendency for the body to develop a hypercoagulable syndrome.

1. Stygar EA, Sergeenkova AS. Arterial hypertension in pregnant women. Smolensk Medical Almanac. 2019;(1):260–264. (In Russ.) https://doi.org/616.12-008.331.1:618.3

2. Bichan NA, Rublevskaya AS, Maltseva NV, Osokina VR, Chernykh NS. Changes in endothelial NO synthase in pregnant women with chronic arterial hypertension and smoking. Medicine in Kuzbass. 2021;(3):55–60. (In Russ.) https://doi.org/10.24412/26870053-2021-3-55-60

3. Diagnostics and treatment of cardiovascular diseases during pregnancy 2018. National recommendations. Russian Journal of Cardiology. 2018;(3):91–134. (In Russ.) https://doi.org/10.15829/15604071-2018-3-91-134

4. Lewandowska M, Więckowska B, Sajdak S. Pre-pregnancy obesity, excessive gestational weight gain, and the risk of pregnancyinduced hypertension and gestational diabetes mellitus. J Clin Med. 2020;9:1980. https://doi.org/10.3390/jcm9061980

5. Bartsch E, Medcalf KE, Park AL, Ray JG, High Risk of Pre-eclampsia Identification Group. Clinical risk factors for preeclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. Br Med J. 2016;353:i1753. https://doi.org/10.1136/bmj.i1753

6. Phipps EA, Thadhani R, Benzing T, Karumanchi SA. Author correction: pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol. 2019;15:386. https://doi. org/10.1038/s41581-019-0156-1

7. Olson KN, Redman LM, Sones JL. Obesity “complements” preeclampsia. Physiol Genom. 2019;51:73–76. https://doi. org/10.1152/physiolgenomics.00102.2018

8. Young OM, Twedt R, Catov JM. Pre-pregnancy maternal obesity and the risk of preterm preeclampsia in the American primigravida. Obesity. 2016;24:1226–1229. https://doi.org/10.1002/oby.21412

9. Golab BP, Santos S, Voerman E, Lawlor DA, Jaddoe VWV, Gaillard R. Influence of maternal obesity on the association between common pregnancy complications and risk of childhood obesity: an individual participant data meta-analysis. Lancet Child Adolesc Health. 2018;2:812–821. https://doi.org/10.1016/S23524642(18)30273-6

10. Skovorodina AV. Influence of geomagnetic disturbances on plasma components of the hemostasis system in pregnant women. International Research Journal. (In Russ.) 2023;138. https://doi.org/10.23670/IRJ.2023.138.120

11. Efimkova EB, Novikova SV, Dulaeva EV, Chechneva MA, Budykina TS, Biryukova NV, et al. Hemostasis indicators in pregnant women with previous novel coronavirus infection COVID-19. Russian Bulletin of Obstetrics and Gynecology. (In Russ.) 2023;23(1):47–55. (In Russ.) https://doi.org/10.17116/rosakush20232301147

12. Kapustin RV, Kopteeva ON, Arzhanova ON, Tiselko AV, Androsova NE, Oparina TI. Features of the state of the coagulation and vascular-platelet link of hemostasis in pregnant women with various types of diabetes mellitus. Diabetes mellitus. (In Russ.) 2021;24(3):251–261. https://doi.org/10.14341/DM12682

13. Tarasova OA, Chulkov VS, Sergeeva VS, Chulkov VlS. The effect of physical activity on cardiometabolic indicators in women with a history of arterial hypertension during pregnancy. Arterial’naya Gipertenziya = Arterial Hypertension. 2024;30(1):83–93. (In Russ.) https://doi.org/10.18705/1607-419X-2024-2390

14. Chernenok ES, Malova RI, Gorbunova AR. The role of obesity in the development of arterial hypertension in pregnant women. Fundamental science and clinical medicine — human and health: proceedings of the XXVIII international medical and biological conference of young researchers, St Petersburg, April 26, 2025. St Petersburg: Sciencia, 2025. P. 150–151. (In Russ.)

15. Vlasova TI, Shishkanova TI, Markina AE, Kapitanova DA, Kirdyashkina OV. Microcirculation and hemostasis disorders in pregnant women with gestational hypertension. Ural Medical Journal. 2025;24(2):30–43. (In Russ.) https://doi.org/10.52420/umj.24.2.30

16. Nikolenko ES, Chulkov VS, Chulkov VlS. Cardiometabolic profile and indicators of daily blood pressure monitoring in pregnant women with white coat hypertension. South Russian Journal of Therapeutic Practice. (In Russ.) 2025;6(1):51–58. https://doi.org/10.21886/2712-8156-2025-6-1-51-58

17. Gaisin IR, Iskhakova AS, Smirnova ES. Management of arterial hypertension in women after childbirth (literature review). Arterial’naya Gipertenziya = Arterial Hypertension. 2022;28(2):126–146. (In Russ.) https://doi.org/10.18705/1607-419X-2022-28-2-126-146

18. Dedov II, Melnichenko GA, Shestakova MV, Troshina EA, Mazurina NV, Shestakova EA, et al. National clinical guidelines for treatment of morbid obesity in adults. Third revision (treatment of morbid obesity in adults). Obesity and metabolism. 2018;15(1):53–70. (In Russ.) https://doi.org/10.14341/omet2018153-70

19. Kobalava ZhD, Konradi AO, Nedogoda SV, Shlyakhto EV, Arutyunov GP, Baranova EI, et al. Arterial hypertension in adults. Clinical guidelines 2024. Russian Journal of Cardiology. 2024;29(9):6117. (In Russ.) https://doi.org/10.15829/1560-4071-2024-6117

20. Ministry of Health of the Russian Federation. Pre-eclampsia. Eclampsia. Oedema, proteinuria and hypertensive disorders during pregnancy, childbirth and the postpartum period [Internet]. Moscow: Ministry of Health of the Russian Federation; 2024 [cited 05.09.2024]. (Clinical guidelines — 637_2). Available from: https://cr.minzdrav.gov.ru/view-cr/637_2

21. Dobrokhotova YuE, Kuznetsov PA, Dzhokhadze LS, Bobrova VA. Normal pregnancy clinical guidelines: new version. Russian Journal of Woman and Child Health. 2024;7(4):296–301. (In Russ.) https://doi.org/10.32364/2618-8430-2024-7-4-1

22. Konyshko NA, Morozova TE, Gertsog AA, Volynets LI. Echocardiographic parameters of the left heart in women with gestational arterial hypertension. Issues of Gynecology, Obstetrics and Perinatology. 2021;20(5):29–35. (In Russ.) https://doi.org/10.20953/17261678-2021-5-29-35

23. Kuzina IA, Goncharova EV, Martirosyan NS, Telnova ME, Atamanova YuA, Yudina KA, et al. Hemostasis in women with obesity and metabolic syndrome. Russian Medical Inquiry. 2021;5(9):598–604. (In Russ.) https://doi.org/10.32364/2587-6821-2021-5-9-598-604

24. Karpova IA. Hemostasis in pregnant women receiving dydrogesterone for the purpose of maintaining pregnancy. University Medicine of the Urals. (In Russ.) 2015;1(2):28–30.

25. Zvonareva EV, Tipikina LA, Zakharenko KV, Garbar ZN, Tretyakova ZS, Fortuna EV. Assessment of hemostasis in pregnant women: status and trends. Public Health of the Far East. 2024;1(99):47–50. (In Russ.) https://doi.org/10.33454/1728-1261-2024-1-47-50

26. Podoplelova NA, Sulimov VB, Tashchilova AS, Ilyin IS, Panteleev MA, Ledeneva IV. Blood coagulation in the 21st century: new knowledge, methods and prospects for therapy. Pediatric Hematology/Oncology and Immunopathology. 2020;19(1):139–157. (In Russ.) https://doi.org/10.24287/1726-1708-2020-19-1-139-157

27. Tannetta D, Sargent I. Placental disease and the maternal syndrome of preeclampsia: missing links? Curr Hypertens Rep. 2013;15(6):590–599. https://doi.org/10.1007/s11906-013-0395-7

28. Tannetta D, Masliukaite I, Vatish M, Redman C, Sargent I. Update of syncytiotrophoblast derived extracellular vesicles in normal pregnancy and preeclampsia. J Reprod Immunol. 2017;119:98– 106. https://doi.org/10.1016/j.jri.2016.08.008

29. Stolyarov GS, Minaeva OV, Fominova GV, Tyurina EP, Amri MS, Kosenko YuYu, et al. Features of the state of central hemodynamics and hemostasis in pregnant women with preeclampsia. [Internet]. Modern Problems of Science and Education. 2018;3:73– [cited 05.09.2024]. (In Russ.) Available from: https://scienceeducation.ru/ru/article/view?id=27712

30. Kuznik IB, Zagorodnyaya ED, Iozefson SA, Isakova NV. Thrombodynamic method for studying the hemostasis system in women with physiologically progressing pregnancy and complicated preeclampsia. Journal of Obstetrics and Women's Diseases. 2018;67(6):38–44. (In Russ.) https://doi.org/10.17816/JOWD67638-44

31. Han L, Liu X, Li H, Zou J, Yang Z, Han J, et al. Blood coagulation parameters and platelet indices: changes in normal and preeclamptic pregnancies and predictive values for preeclampsia. PLoS One. 2014;9(12):e114488. https://doi.org/10.1371/journal.pone.0114488

32. Chen Sh, Zhang M. Clinical application of combined measurement of cardiac injury markers and platelet parameters in pregnant women with preeclampsia. Kardiologiia. 2025;65(9):7281. (In Russ.) https://doi.org/10.18087/cardio.2025.9.n2953