Бюллетень сибирской медицины (Aug 2014)
HEALTH TECHNOLOGIES FOR INCREASING ADAPTIVE CAPABILITIESOF PREGNANT WOMEN
Abstract
Our research is aimed to investigate the influence of breathing exercises and aqua-gymnastics on the adaptive capabilities of pregnant women in different trimesters of gestation.The estimation of adaptive capabilities of the pregnant women organism was carried out on the basis of functional tests on breath-holding duration – Stange’s test (for inhalation) and Ghencea’s test (for exhalation) in the initial period, 11–19, 21–29 and 31–39 weeks periods of pregnancy.To identify the adaptation strategies for pregnant women the method proposed by Ya.S. Pekker and A. Rotov was used, namely, the consideration of information measure as a measure of biological object preference behavior. Analysis of the results with information criterion of curve types using cluster analysis allowed to identify 4 standard types of adaptation strategies for pregnant women: adaptive, compensatory, compensatory-adaptive and maladaptive compensatory type of response. To estimate the adaptive capabilities of the respiratory system the ratio between the level of respiratory system functioning, its functional reserve and the degree of stress regulation mechanisms was considered.The intensity of lipid peroxidation processes (LPO) in the blood serum of pregnant women was assessed by determining malondialdehyde (MDA) in the reaction with 2-thiobarbituric acid. Determination of vitamin D content in blood serum was estimated by fluorimetric method using spectrophotometer «Hitachi-85» (Japan) at an excitation wavelength of 295 nm and 320 nm fluorescence. Determination of the level of stress hormones (cortisol, insulin) in the blood serum of pregnant women was performed by radio ligand assay.The following somatic diseases were registered among pregnant women applying to hospital: chronic tonsillitis, sinusitis, vasomotor rhinitis, bronchitis, bronchial asthma, hay fever, chronic pyelonephritis, atopic dermatitis. The next prenatal risks were revealed: morning sickness in I and II half of pregnancy, anemia, the threat of pregnancy termination, hypertension and hypotension.The complex of breathing exercises and aqua-gymnastics was carried out as follows. Firstly the presence of somatic diseases and prenatal risk factors (ultrasound, CTG, Doppler) were confirmed. Then terminating breath tests were carried out, after which the complex of breathing exercises and aqua-gymnastics was put on.Carrying out this complex by main group women allowed increasing their functional reserves level and forming a good adaptation to the various factors of external and internal environment, as indicated by the adaptive type of response in 64% of the cases. There was a gradual decline in the functional reserves of pregnant women with somatic morbidity and prenatal risk factors who did not make the complex of breathing exercises and aqua-gymnastics that indicates the possible worsening of somatic pathology. Subsequently, these women have a disease recurrence contributed to a further decrease in functional reserves, which led to the breakdown of adaptation in 35% of cases.The performing of breathing exercises and aqua-gymnastics had a positive effect on the hormonal and metabolic status of pregnant women. In the first trimester cortisol concentration was significantly lower in women of main group and comparison group compared to control group. Against the background of the active respiratory training within the main group of women it was shown normalization of this hormone concentration in the blood serum up to the performance level of healthy mothers. Indices of insulin in the blood serum against the background of pregnancy also tended to increase, but they remained within the reference ranges.Breathing exercises combined with aqua-gymnastics helped to increase the sensitivity to hormones and exerted a stimulating effect on the secretion of glucocorticoid effect.In the main group of women against the background of the respiratory training in the third trimester of pregnancy it were identified lower rates of lipid peroxidation compared with those observed during pregnancy in the usual way (control group), which corresponded to women's health indicators. At the same time in the third trimester of pregnancy it was found a significant increase in the concentration of vitamin E in the blood serum of women from the main group compared to the control group (p < 0.001).The complex of breathing exercises and aqua-gymnastics have a stimulating effect on metabolism, thereby it normalizes the level of antioxidant enzyme. During the breathing exercises process a direct correlation was revealed between the level of MDA and cortisol (r = 0.67) and between vitamin E and insulin (r = 0.61). These data allow suggesting the prospects for determining the concentration of MDA and vitamin E in the peripheral blood of pregnant women to determine the adaptive capability of the organism and the favorable course of pregnancy and childbirth.It is possible that the complex of adaptive respiratory and aqua-gymnastics performing by pregnant women promotes more intensive penetration of oxygen from the blood to tissue, which leads to better oxidation of the substrate and hence reduce the concentration of MDA in women of main group. Timely addition of breathing exercises complex during pregnancy, as well as aqua-gymnastics, promotes restoration of redox enzymatic processes in the tissues, leading to improved utilization of fetal oxygen; contributes to Verigo–Bohr strengthening effect, intensive penetration of oxygen from the blood into tissues, resulting in the release of carbon dioxide. Accumulated carbon dioxide promotes active oxygen transportation to the fetus and increases the adaptive capabilities of the organism.Thus, the experience of working with groups of pregnant women with somatic pathology and prenatal risk factors, allowed us to estimate the effectiveness of breathing exercises combined with aqua-gymnastics and develop a more sophisticated approach to the restoration of functional reserves due to the activation of natural mechanisms of recovery.The results of this method were characterized by a decrease in cases of pregnant women hospitalization, decrease of the fetal hypoxia degree, the successful outcome of pregnancies. The usage of complex of breathing exercises combined with aqua-gymnastics, modulating antioxidant activity in the organism, can be a crucial factor in improving the functional reserves when there are any complications in pregnancy. In addition, there is the decrease in maternal mortality in 1.9 times.
Keywords
