The prevalence of gestational diabetes parallels the prevalence of type 2 diabetes mellitus and is associated with adverse pregnancy outcomes. However, these data are not available for many parts of the world. We assessed the prevalence of gestational diabetes and pregnancy outcomes in Tajikistan. This cohort study included 2438 consecutively recruited representative pregnant women from 8 locations in two cities in Tajikistan, in whom an oral glucose tolerance test (75 g, fasting, 1 h, 2 h) was performed during gestational weeks 24–28. Women with known diabetes and twin pregnancies were excluded. Associations between glucose tolerance test results and pregnancy outcomes were examined. According to the WHO 2013 thresholds, 32.4% of women qualified as having gestational diabetes, the vast majority (29.7%) based on an elevated fasting glucose level (5.1–5.6 mmol/L), while only 2.8% had elevated 1- or 2-hour values or met more than one threshold. Women with only elevated fasting glucose (impaired gestational fasting glycemia) had no evidence of adverse pregnancy outcomes, while those with elevated 1- and/or 2-hour values (impaired gestational glucose tolerance) had more pregnancy complications (infection of urinary tract 1.8 vs. 8.8% p<0.001; preeclampsia 0.7 vs. 10.3% p<0.001) and emergency cesarean sections (4.4 vs. 13.2% p=0.002). Neonates from pregnancies with impaired gestational glucose tolerance had lower APGARs, lower birth weights, lower 30 min glucose levels, and a lower probability of being discharged alive (all p<0.05). In conclusion, the formal prevalence of gestational diabetes is high in Tajikistan; however, this does not translate into adverse pregnancy outcomes for women with impaired gestational fasting glycemia.

Objective: To study immunohystochemical markers and features of histological and morphological changes in the placenta of women who have given birth to children with anencephaly. Methods: 15 women with anencephaly in the fetus (the main group) and 20 women, who gave birth to practically healthy children (control group), were examined. All women were tested for tumor marker alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG), morphological examination of placenta and levels of apoptosis, definition expression Nkx-2.2 in vascular endothelial cells of the villous chorion of the placenta of women in norm, and with congenital malformation (CM) of the central nervous system (CNS), in particular – anencephaly in the fetus. Results: A feature of the histochemical characteristics of placenta in women who have given birth to children with anencephaly is the predominance of chronic compensated deficiency with manifestations of dyscirculatory disorders. Statistically significant reduction of Nkx-2.2 expression levels in the vascular endothelial cells of the villous chorion placenta of women who gave birth to children with anencephaly, confirms the role of this factor in the differentiation of nervous structures. An inverse correlation between the level of Nkx-2.2 expression in the placenta and the level of AFP in the blood serum of pregnant women at the beginning of the second trimester of pregnancy determines the level of AFP as the most significant marker of the development of anencephaly in the fetus. Conclusions: Based on the conducted studies it is possible to assume the participation of the placenta in the formation of abnormalities of the CNS of fetuses and newborns. Consequently, properly organized antenatal surveillance with mandatory definition of AFP level at 14 weeks of pregnancy will improve the quality of care for women at risk development of CM of the CNS of the fetus, in particular – anencephaly. Keywords: Immunohistochemical markers, diagnostics of anencephaly, expression of Nkx-2.2 in the placenta, degree of apoptosis in the placenta

Кафедра акушерства и гинекологии № 1, Таджикский государственный медицинский университет им. абуали ибни Сино, Душанбе, Республика Таджикистан На основании анализа мировой литературы выяснилось, что преэклампсия, как лидирующая причина материнской и перинатальной заболеваемости и смертности, в настоящее время остаётся одним из нерешённых акушерских вопросов во всем мире. Негативное влияние преэклампсии на беременность и перинатальные исходы отражается на качестве жизни не только матери, но и будущего потомства, что является проблемой общественного здравоохранения и которую необходимо решать особенно развивающимся странам. Ключевые слова: преэклампсия, беременность, профилактика.

Objective: To study the features of the morphological structure of placenta in puerperas with gestational diabetes mellitus (GDM) and anemia. Methods: The study targeted 42 afterbirths, including 13 placentae from puerperas in GDM combined with anemia, 10 from puerperas with only GDM and 8 from puerperas with only the anemia. Comparison group accounted for 11 placentae from healthy puerperas. For histological research prepared paraffin slices of thickness from 3 to 5 microns, hematoxylin and eosin used for the review coloring. The morphological features were evaluated on the Olympus CX-21 microscope. Results: Women in GDM combined with anemia have had a decrease in placenta size, an increase in placental fetal ratio and a shortening of the umbilical cord with its eccentric attachment to the placenta. At the same time microscopically dominated dissociated forms of villous maturation, syncytiotrophoblast dystrophy with alternating syncytium atrophy sites, villous fibrosis, and stromal edema with inflammatory changes, which indicated circulatory-metabolic disorders associated with placental insufficiency. Compensatory adaptive reactions in the GDM group, combined with anemia, were mainly due to a relative increase in the number of terminal and specialized villi, along with the pronounced phenomena of angiomatosis. Conclusion: Gestational diabetes and anemia in pregnant women lead to the development of placental insufficiency, pathomorphologically manifested involutive and dystrophic changes, circulatory disorders, inflammatory processes and compensatory adaptive reactions, which are expressed more in the combination of these diseases. Keywords: Gestational diabetes, anemia, morphological structure of the placenta, involutive and dystrophic changes, compensatory-adaptive reactions.

Кафедра акушерства и гинекологии № 1, Таджикский государственный медицинский университет им. абуали ибни Сино, Душанбе, Республика Таджикистан На основании анализа мировой литературы выяснилось, что изменение климата в сторону потепления ухудшает течение беременности и перинатальные исходы. Однако результаты многочисленных исследований, проведённых в разных частях мира по изучению корреляции между температурой окружающей среды, относительной влажностью воздуха и интенсивностью солнечного света, а также частотой гипертензивных расстройств во время беременности, противоречивы. Несмотря на расхождения в результатах, в течение холодных месяцев наблюдается тенденция к более высокой заболеваемости преэклампсией. Объяснением в поддержку этой теории было бы то, что более низкие температуры влияют на заболеваемость преэклампсией и эклампсией, усиливая вазоспазм, свойственный заболеванию. Признание точной связи с разными погодными условиями может помочь понять, какие факторы могут участвовать в запуске этих процессов. Эти исследования особенно актуальны в условиях Таджикистана, где к массе экстрагенитальных заболеваний, имеющихся у беременных женщин региона, присоединяется ещё и фактор потепления климата.