The aim of the study: to evaluate the cytokine profile state in pregnant women with non-alcoholic fatty liver disease (NAFLD) at the stage of non-alcoholic steatohepatitis (NASH) with varying degrees of obesity under the influence of the developed complex therapy program. Material and methods. We examined 197 pregnant women with NAFLD at the stage of NASH in combination with obesity. The main group I consisted of 98 pregnant women with NAFLD at the stage of NASH with varying degrees of obesity, who were divided into 3 subgroups depending on body mass index (BMI). Among them, 26 pregnant women with BMI of 25.0–29.9 kg/m2 were included in IA group, 48 pregnant women with BMI of 30.0–34.9 kg/m2 were included in IB group, and 24 pregnant women with BMI of 35.0–39.9 kg/m2 – in IC group. All pregnant women in the main group were prescribed complex therapy including vitamin E at a dose of 400 IU/day, ursodeoxycholic acid (UDCA) at a dose of 15 mg/kg/day, and L-carnitine at a dose of 3 g per day. The comparison group consisted of 69 women with NAFLD at the stage of NASH and abdominal obesity, who corresponded to subgroups of the main group (IIA – 23 patients, IIB – 25 women, IIC – 21 pregnant women) and received basic therapy. The control group consisted of 30 healthy women. To evaluate the cytokine profile, levels of IL-1β, IL-6, IL-10 and TNF-α were determined by ELISPOT. Results. Analysis of the cytokine profile in women with NASH and obesity showed the presence of systemic inflammation links in the examined groups, which was manifested by increased levels of pro-inflammatory and decreased levels of anti-inflammatory interleukins in blood serum of pregnant women. A prescription of the complex treatment contributed to a decreased activity of the inflammatory response, which was manifested by an improvement in the levels of cytokine profile indicators. Conclusions. NASH during pregnancy is accompanied by significant changes in the cytokine profile. The prescription of complex therapy in the form of vitamin E, UDCA and L-carnitine is effective in the treatment of pregnant women with NAFLD at the stage of NASH due to cumulative and potentiating effects, reducing manifestations of systemic inflammation by normalizing the level of cytokines.

The aim of our study is to assess the development of obstetric and perinatal complications in obese pregnant women with non-alcoholic steatohepatitis (NASH) depending on changes in blood lipid spectrum and body mass index (BMI). Materials and methods. We examined 98 pregnant women with non-alcoholic fatty liver disease (NAFLD) at the stage of NASH in combination with obesity. The control group consisted of 30 healthy pregnant women. All pregnant women with NAFLD and abdominal obesity were divided into 3 groups depending on BMI: Group I – 26 pregnant women with BMI 25.0–29.9 kg/m², Group II – 48 pregnant women with BMI 30.0–34.9 kg/m2, Group III – 24 pregnant women with BMI 35.0–39.9 kg/m2. Correlations of obstetric complications depending on changes in lipid metabolism and BMI were determined. Results. The analysis of obstetric complications revealed 3.4 times higher risk of early miscarriage in group I, 5.6 times – in group II, 7.5 times – in group III compared the control group (P < 0.05); early gestosis occurred 1.9 times more often in group I, 2.5 times – in group II, 3.3 times – in group III as compared to that in pregnant women of the control group (P < 0.05); the threat of premature birth was found 3.4 times more frequently in group I, 5.6 times – in group II, 7.5 times – in group III as compared with the control group (P < 0.05). Group I patients developed placental dysfunction with a frequency of 2.3 times, group II – of 4.0 times, and group III – of 6.3 times greater than pregnant women of the control group (P < 0.05), and moderate preeclampsia was diagnosed in overweight pregnant women, as well as in women with grade I and grade II–III obesity 2.3 times, 4.7 times and 5.6 times as often, respectively, as in the control group (P < 0.05). Correlation analysis showed correlations between lipid metabolism indicators and an increase in BMI. Conclusions. Obese pregnant women with NAFLD at the stage of NASH were found to have significantly more frequent obstetric and perinatal complications as well as lipid profile abnormalities correlating with increased BMI, which may be due to the presence of NASH and functional liver failure.