Резюме. У женщин с ановуляторным синдромом и нарушением репродуктивной функции персистирующая ациклическая гипоэстрогенемия и недостаточность прогестерона связаны с нарушением морфологической структуры эндометрия, повышенной экспрессией рецепторов эстрогенов, прогестерона, перераспределением NK-клеток с преобладанием CD16 + NK-клеток в эндометрии, при этом сниженное количество CD16 + NK-клеток и цитотоксических CD8 + Т-лимфоцитов в крови сочеталось с повышением уровнем IFNγ в сыворотке и увеличением спонтанной продукции TNFα. Ключевые слова: репродуктивная функция, гормональная недостаточность яичников, эндометрий, половые стероиды и их рецепторы, местный и системный иммунитет.

The aim of this study was to improve the method for diagnosing insulin resistance (IR) and to assess the effect of pregravid diet alone or dietary supplementation in combination with metformin on the development of gestational diabetes mellitus (GDM) and its complications in patients with pre-diabetes. At the first stage of the study, glucose level was determined in the capillary blood of 61 women and, in the second stage, in the venous blood plasma of 60 individuals. The 75 g oral glucose tolerance test was performed in all patients. Plasma insulin level and IR index were determined basal (HOMA-IR) and two hours after the glucose load. The presence of IR was found in 68 women. All of them were treated with a diet, with 34 patients additionally treated with metformin at a dose of 1500 mg per day. The duration of therapy was 3-6 months.It has been shown that the evaluation of IR index two hours after the glucose load significantly (p < 0.05) increases the diagnosis of the IR status, as in 56.5% of women with IR, the fasting IR (HOMA-IR) values were normal. The use of metformin combined with diet therapy in patients with IR, with easily assimilated carbohydrates excluded at the pregravid stage, is accompanied by a more significant loss of body weight with the achievement of a normal body mass index for pregnancy, when compared to diet therapy alone. In patients with IR after pregravid treatment with diet or diet with metformin, the frequency of obstetric complications, as well as of gestational diabetes mellitus, is comparable with that in normal women. In addition, such pregravid treatment protects patiens with IR from superfluous weight gain and fetal macrosomia. (For citation: Komarov ЕК, Pluzhnikova ТА, Nikologorskaya ЕV, Alyabyeva ЕА. Role of pregravid diet and metformin in the prophylaxis of gestational diabetes and its complications. Journal of Obstetrics and Women’s Diseases. 2018;67(4):13-18. doi: 10.17816/JOWD67413-18).

The CYP17A1 gene encodes the most important stages of sex steroid biosynthesis by the adrenal glands and ovaries. The objective of this study was to evaluate the hormonal and metabolic status of patients with hyperandrogenia and the CYP17A1 rs743572 gene polymorphism. We examined 106 women with polycystic ovary syndrome androgen phenotypes A, B, and C and 28 women with latent non-classic congenital adrenal hyperplasia. It was found that there were no significant differences in the frequency of CYP17A1 alleles and genotypes between the three phenotype groups of patients with polycystic ovary syndrome. Body mass index and insulin resistance after glucose loading were comparable in individuals with these phenotypes of polycystic ovary syndrome. The CYP17A1 gene polymorphism in patients with different polycystic ovary syndrome phenotypes and in individuals with latent non-classic congenital adrenal hyperplasia did not associate with the concentration of estradiol and androgens in the blood. Neither did LH / FSH ratio differ between groups with different allelic variants of the CYP17A1 gene. These results show that patients with different polycystic ovary syndrome phenotypes do not require differentiated therapy. Serum levels of DHEA-S and cortisol were elevated in 38.7% of women with polycystic ovary syndrome without non-classic congenital adrenal hyperplasia, which indicates an adrenal cause of hyperandrogenia. We suppose that in the diagnosis of polycystic ovary syndrome, it is necessary to define not only phenotypes, but also a suprarenal source of androgens. The therapy of these patients may require application of corticosteroids besides the usual methods in planning of pregnancy.

Aims of this article consists in analysis of the rate of the most important reasons of miscarriages and in estimation of effectiveness of pregravid therapy of wemen with miscarriages in the past who were patients of Center in 2014. The most important reasons were the infection of genital tract (60 %), inherited thrombophilia (95 %) and AFS (3,2 %), endocrine diseases with secondary or initial insufficiency of corpus luteum (35 %), chronic endometritis (60 %). There were presented results of the investigation of the significance of insulin resistance in the pathogenesis of miscarriages and the efficiency of the treatment with metformin patients with prediabetes. There were analysed the course and results of pregnancy in 354 women with miscarriages in the past. In 92 % of women the pregnancy complete by delivery of alive baby. This results demonstrate the effectiveness of pregravid preparation of women with miscarriages in the past.