Background and Objective — Subclinical gestational hypothyroidism (SGH) and gestational diabetes mellitus (GDM) constitute two most common endocrine pathologies encountered during pregnancy. SGH and GDM have common pathophysiological mechanisms, being interrelated pathological conditions that are capable of complicating the course of pregnancy, labor and the postpartum period both on the part of the mother and on the part of the fetus. We aimed to analyze the relationship between these pathologies and to assess the risk of developing GDM against the background of hypothyroidism. Materials and Methods — the study included 200 pregnant women observed at the Perinatal Center of the Maternity Hospital the Bauman State Clinical Hospital No. 29 during 2018-2020. The main group consisted of 133 women who visited the perinatal center for hypothyroidism (both SGH and primary hypothyroidism, detected prior to pregnancy); the control group comprised 67 women without endocrine pathology. Both groups were comparable in terms of age, height, weight, and the number of pregnancies in the anamneses. The main group received levothyroxine sodium therapy with the achievement of the target trimester-specific level of thyroid-stimulating hormone (TSH). The criteria for the diagnosis of SGH were the TSH level above 2.5 μIU/mL in combination with an enlarged titer of antithyroid antibodies and/or a burdened medical history of thyroid pathology, or the TSH level above 4.0 μIU/mL in the absence of antithyroid antibodies [1]. The diagnosis of GDM was established on the basis of fasting hyperglycemia (≥5.1 mmol/L), or based on the results of an oral glucose tolerance test (OGTT) with 75 g of glucose: fasting glucose level of ≥5.1 mmol/L; the concentration 1 hour after glucose intake ≥10.0 mmol/L; the content 2 hours after glucose intake ≥8.5 mmol/l) [2]. In both groups, the frequency of developing GDM, the timing of diagnosis, and the need for insulin therapy were evaluated. Statistical data processing was carried out using the StatTech v. 2.1.0 software. Quantitative indicators were assessed for compliance with the normal distribution via Shapiro-Wilk criterion or Kolmogorov-Smirnov criterion. Intergroup comparison was performed using Mann-Whitney U test or Pearson’s chi-squared test. Results — We discovered that among women with a burdened family history of thyroid pathology and diabetes mellitus, as well as with thyroid pathology prior to pregnancy, the prevalence of hypothyroidism was higher. The presence of thyroid pathology in the anamnesis of pregnant women was associated with an earlier diagnosis of hypothyroidism. We revealed a significant difference in the prevalence of GDM between two groups of subjects. The chances of detecting GDM in the hypothyroidism group were 8.6 times higher than in the euthyroidism group. The threshold level of TSH for the first trimester, predicting the development of GDM, was identified. The sensitivity and specificity of the model were 71.4% and 63.1%, respectively. Conclusion — Hypofunction of the thyroid and GDM are interrelated endocrine pathologies. In the presence of hypothyroidism (both primary and SGH), GDM develops significantly more often. The level of TSH in the first trimester ≥2.7 μIU/mL amplifies the chance of developing GDM by over 8 times; hence, it could be considered a signal for timely prevention and detection of this pathology.

Metabolic syndrome (MS) is a combination of impaired glucose metabolism, abdominal obesity, dyslipidemia, and hypertension and is associated with the development of type 2 diabetes (T2D) and cardiovascular disease (CVD). Despite numerous studies on this subject, the terminology and the definition of MS as well as borderline values for its criteria are not defined. From the standpoint of public health and clinical practice, the early detection of MS is highly important in order to prevent the development of CVD and T2D. This review article reflects the stages of development of the concept of MS, expresses the opinion of the authors with respect to the modern view of the problem and analyzes of contemporary arguments "for" and "against" the use of MS diagnosis in clinical practice.

The Goal of this study was to investigate the efficacy of the integrated approach for the treatment of metabolic syndrome (MS) aiming to correct all of its components versus standard therapy using clinical outcomes (BMI, waist circumference, blood pressure, lipid levels), assessment of psychological status (Beck Depression Inventory), and quality of life (SF-36). Methods: A total of 60 patients with MS were included in the study. The study group (30 subjects mean age 41.0±11 years, women - 23 (76.7%), men - 7 (23.3%)) received the complex therapy of MS - pharmacotherapy of obesity (orlistat) and insulin resistance (metformin), lipid-lowering therapy (statins or fibrates), antihypertensive therapy. Control group (30 patients mean age 43.4±9.5 years, women - 26 (86.7%), men - 4 (13.3%)) was treated with statins or fibrates and received antihypertensive therapy when needed. At the inclusion in the study and after 6 months of therapy all patients underwent clinical and laboratory investigation, assessment of depression and quality of life. Results: We found a more significant reduction of all clinical outcomes (body weight, blood pressure, improvement in glucose and lipid metabolism), a significant decrease in the prevalence and severity of the depression, and an improvement in the quality of life in patients of study group compared with standard therapy. Conclusion: Complex treatment of the MS, including pharmacotherapy of obesity (orlistat, Xenical) and insulin resistance (metformin, Glucophage) is characterized by a greater clinical efficacy compared with standard therapy.

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Gestational diabetes (GD) is one of the frequent complications of pregnancy, which increases the risk of short- and long-term adverse outcomes in both mother and offspring. However, the pathophysiological mechanism of GD has not been sufficiently studied. Genetic predisposition and epigenetic influence, systemic inflammation, insulin resistance, oxidative stress, and carbohydrate metabolism disorders may be determining factors in the onset and development of GD. Although significant progress has been made in the treatment of GD over the past decade, the impact of this complication on pregnancy, childbirth, and the future health of both the woman and fetus cannot be ignored. This article reviews recent literature and discusses the relationship between the intake of various micronutrients during pregnancy and the risk of developing GD to provide some recommendations for preventing and treating this condition and improving pregnancy outcomes. Key words: gestational diabetes, insulin resistance, nutrients, micronutrients, macronutrients, vitamin D, myo-inositol