Учредитель и издатель Федеральное государственное бюджетное образовательное учреждение высшего образования «Алтайский государственный медицинский университет» Министерства здравоохранения Российской Федерации (ФГБОУ ВО АГМУ Минздрава России) 656038, РФ, Алтайский край, Барнаул, проспект Ленина, 40 www.asmu.ru РЕДАКЦИЯ Главный редактор Салдан Игорь Петрович доктор медицинских наук, профессор Заместитель главного редактора Жариков Александр Юрьевич доктор биологических наук, профессор Редактор-организатор Киселев Валерий Иванович член-корреспондент РАН, доктор медицинских наук, профессор Выпускающий редактор Широкоступ Сергей Васильевич кандидат медицинских наук, доцент Научные редакторы Шойхет Яков Нахманович член-корреспондент РАН, доктор медицинских наук, профессор Брюханов Валерий Михайлович доктор медицинских наук, профессор Колядо Владимир Борисович доктор медицинских наук, профессор Лукьяненко Наталья Валентиновна доктор медицинских наук, профессор Редакционная коллегия Брико Николай Иванович академик РАН, доктор медицинских наук, профессор Воевода Михаил Иванович академик РАН, доктор медицинских наук, профессор Дыгай Александр Михайлович академик РАН, доктор медицинских наук, профессор Злобин Владимир Игоревич академик РАН, доктор медицинских наук, профессор Лобзин Юрий Владимирович академик РАН, доктор медицинских наук, профессор Онищенко Геннадий Григорьевич академик РАН, доктор медицинских наук, профессор Полушин Юрий Сергеевич академик РАН, доктор медицинских наук, профессор Рахманин Юрий Анатольевич академик РАН, доктор медицинских наук, профессор Ответственный за перевод

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Vulvovaginal atrophy is one of the genitourinary symptoms caused by estrogen deficiency which leads to the development of immature vaginal epithelium, glycogen deficiency, reduction or even elimination of lactobacilli, and secondary genitourinary tract infection. Among the main symptoms were dryness, burning, itching, and dyspareunia. Diagnosis is typically based on the patient’s complaints, signs, and symptoms. Management of vulvovaginal atrophy includes various forms of topical estrogens and non-hormonal drugs. Low-dose vaginal estrogens can be used as monotherapy or as a supplement to hormone replacement therapy (HRT). In the case of monotherapy, there is no need to add progesterone for the endometrial protection. According to the recent studies, local vaginal estrogen therapy does not increase the risk of cancer, cardiovascular disease, and venous thromboembolism. On patients with hormonophobia, an alternative method of treatment is the use of vaginal lubricants and moisturizers or who have had cancers of various localization. For instance, usage of lactic acid vaginal gels in breast cancer survivors has improved vaginal dryness and dyspareunia as compared with the placebo. Yet, vaginal estrogen therapy has better clinical effects than non-hormonal drugs.

Aim: to identify the risk factors for gestational diabetes mellitus (GDМ) and predictors of perinatal lesions of central nervous system (CNS) combined with GDМ and maternal obesity.Materials and Methods. А retrospective observational case-control non-combined study was conducted to determine GDМ risk factors and their effect on perinatal pathology in 250 women divided into 2 groups. The main group included 150 pregnant women diagnosed with GDМ, the control group – 100 pregnant women without carbohydrate metabolism disorders. An assessment of hereditary, obstetric and gynecological history, as well as somatic health was carried out. Patients from the main group were subdivided into smaller groups: 1А (n = 77) – mothers whose newborns postnatally exerted adverse perinatal outcomes associated with impacting maternal hyperglycemia, and 1В (n = 73) – mothers whose newborns were born healthy. CHAID method (Chi Squared Automatic Interaction Detection) was used to create an algorithm for predicting adverse perinatal outcomes in GDМ. Аt the second stage, a single-center prospective observational non-combined cohort study was conducted to assess an effect of maternal hyperglycemia on formation of perinatal CNS lesions. Pre-labor concentration of neuron-specific enolase (NSE) was measured in the amniotic fluid of full-term fetuses in the group of pregnant women with GDM (n = 33) and in the group of pregnant women lacking carbohydrate metabolism disorders (n = 42).Results. Obesity, late reproductive age, family history of type 2 diabetes mellitus, abortions, early reproductive losses, macrosomic delivery in history are the main risk factors for GDM development. An algorithm was developed that allowed to predict a risk of newborn perinatal pathology in mother with GDM with an overall percentage of correct predictions of 68.7 ± 3.8 %. Pre-labor concentration of NSE in the amniotic fluid of full-term fetuses was elevated by 1.68 times (p = 0.006) in women with combined GDM and obesity (5.56 [3.37–6.24] ng/ml) compared to pregnant women with normal weight lacking carbohydrate metabolism disorders (3.29 [1.49–4.89] ng/ml).Conclusion. Pregnant women with obesity and type 2 diabetes mellitus familial history were featured with most prominent potential of developing perinatal complications. Rise in amniotic fluid NSE level in patients with GDМ corroborates damage of fetal CNS during antenatal period. The maximum NSE level was found in women comorbid with GDM and obesity.

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