Predicting impairment of pre-lactation transformation and preventing lactogenesis failure in metabolic syndrome

Objective. To identify the features of pre-lactation transformation and the initiation of lactation in the metabolic syndrome to develop a new pathogenetically based method for predicting and preventing early hypogalactia. Material and methods. To develop a predictive model of the risk of early hypogalactia and evaluate the effectiveness of a staged non-pharmacological complex of preventive measures, including prenatal colostrum expression and phototherapy with visible infrared polarized polychromatic non-coherent light in the metabolic syndrome, 184 pregnant women with metabolic syndrome were examined; 35 healthy pregnant women were enrolled in the control group. Diagnostic evaluation included ultrasound examination, biochemical and immunological testing. The effectiveness of the method for preventing early hypogalactia was evaluated by the methodological standards of evidence-based medicine. Results. The performance of the predictive model of impaired lactogenesis in women with metabolic syndrome, based on the characteristics of the pre-lactation transformation of the mammary glands, confirmed the advantage of the standardized multicomponent approach over individual predictors - AUC = 0.74; standard error of AUC = 0.08; p = 0.006. The quality of prediction of early hypogalactia using the predictive model with the separation point d = 0.78: Se = 74%, Sp = 81% (p < 0.05). Key indicators of the effect of preventive intervention in relation to early hypogalactia confirmed the high efficiency of the proposed method: the rate of early hypogalactia and lactostasis decreased from 75% to 10.4% and from 22.7% to 2%, respectively, the NNT was 2 (95% CI1-2, p < 0.05), OR 0.04 (95% CI 0.02-0.1, p < 0.05). Conclusion. The developed staged prediction and prevention of incomplete gestational mammogenesis and impaired lactation in women with metabolic syndrome is based on a complex pathogenetic approach to support breastfeeding, thus optimizing medical management aimed to improve lactopoiesis.

metabolic syndrome, mammogenesis, lactogenesis, hypogalactia, prognosis, prevention