Currently, the reduction of perinatal morbidity and mortality is a key challenge of maternity care in the world. An important role in the structure of perinatal pathology plays a gestational diabetes mellitus (GDM). High incidence of gestational diabetes mellitus (1-14%) and the associated perinatal mortality have not only medical but also social value. The aim of the study was to study the pathophysiological processes that occur in the body of the pregnant woman with GDM and lead to obstetric and perinatal complications, and possible genetic markers that increase execution risks of impaired glucose metabolism in pregnancy at the present stage of scientific development. Materials: literature data of domestic and foreign studies over the period 2006 to 2016. Methods: synthesis of literature data. Conclusion. It is necessary to identify the major genetic predictors of the development of gestational diabetes, with the aim of its prediction and timely prevention of obstetric and perinatal complications.

Gestational diabetes mellitus (GDM) and its consequences for the mother and child represent a serious not only medical, but also an economic problem. The urgency of studying this problem also lies in the fact that the number of pregnant women suffering from this disease is progressively increasing. The aim of the study was to study the risk factors and features of the course of pregnancy and childbirth in women with gestational diabetes mellitus, as well as to improve methods for diagnosing and predicting the development of diabetic fetopathy (DF). The work was carried out in 3 stages: 1 — prospective study of the course of pregnancy and childbirth in 104 women with GDM and in 50 pregnant women without GDM (control group); 2 — determination in the peripheral blood of the pregnant women of both groups of the level of glycemia, C-peptide, insulin, calculation of the insulin resistance index (HOMA-IR) with an assessment of the prognostic significance of these markers in the development of diabetic fetopathy; 3 — prediction of the development of diabetic fetopathy using a mathematical model that includes risk factors, the results of laboratory and instrumental research methods for this pathology. It was found that the violation of carbohydrate metabolism during pregnancy promotes the development of a large number of obstetric complications and in 36.5% of cases leads to the birth of children with diabetic fetopathy, which is manifested to a greater degree by macrosomia (30%), which increases the risk of perinatal complications and worsens the course of the period newborn in the future. An increase in the level of C-peptide was diagnosed in 87% of pregnant women with gestational diabetes, and an increase in the insulin resistance index in 93%, in contrast to the control group, where these indicators were 4 and 6%, respectively (p < 0.05). Using discriminant analysis, it was determined that the threshold for predicting the development of DF should be considered an increase in HOMA-IR above 7 with a confidence of 73%, but the level of C- peptide does not have a predictive value. The mathematical model, including risk factors, data of laboratory and instrumental methods for studying carbohydrate metabolism in the mother and fetus, created using regression analysis, reflects the probability of development of diabetic fetopathy in pregnant women with gestational diabetes with an accuracy of 91.4%, which will help to prevent this complication in at an earlier stage through insulin therapy.

Нормальное содержание витамина D в крови является одним из ключевых факторов, обеспечивающих гинекологическое здоровье и реализацию репродуктивной функции женщины. D-гормон обеспечивает созревание фолликула и рост эндометрия, поэтому его дефицит, в свою очередь, негативно влияет на фертильность, процессы имплантации и развитие беременности. Цель исследования -провести анализ акушерско-гинекологической заболеваемости у пациенток с эндокринной формой бесплодия, а также изучить влияние дефицита витамина D на репродуктивную функцию женщин. Обследованы 70 пациенток с эндокринным бесплодием в возрасте 25-40 лет. Критериями исключения стали пациентки с трубноперитонеальным и неуточненным формами бесплодия, сахарным диабетом 1-го и 2-го типа, женщины старше 40 лет. Объем исследования включал определение уровня витамина D по содержанию 25(ОН)D в сыворотке крови методом ИФА. В контрольную группу включены 50 женщин, не имеющих проблем с зачатием. В результате проведенного исследования выявлено, что женщины с бесплодием имеют низкую обеспеченность витамином D и высокую гинекологическую и соматическую заболеваемость. Дефицит витамина D у пациенток с бесплодием встречается в 3,5 раза чаще, особенно при наличии синдрома поликистозных яичников и эндометриоза, в сравнении с женщинами без нарушения репродуктивной функции. Ключевые слова: бесплодие, витамин D, ожирение, гинекологическая патология, эндометриоз.

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