Vol 67, No 3 (2018)

The effect of vitamin D on women’s reproductive health
Bakleicheva M.O., Kovaleva I.V., Bespalova O.N., Kogan I.Y.

Background. According to WHO data (2014), more than two billion people are deficient in microelements or have a “hidden hunger” due to the deficiencies of vitamins and minerals. Currently, experts estimate the vitamin D deficiency as a new type of pandemic of the XXI century.

Aim. The current analysis was undertaken to evaluate the effect of vitamin D on women’s reproductive health.

Materials and Methods. Based on the findings of retrospective and prospective studies, meta-analyzes, and material trials over the past 20 years, as well as in accordance with the results of 290 prospective cohort randomized trials, the level of vitamin D affects 172 basic physiological indicators associated with the risk of such complications of pregnancy as miscarriage, preeclampsia, gestational diabetes mellitus, and bacterial vaginosis.

Results. Vitamin D has been shown to be able to act as an immune regulator during the implantation. The placenta produces and responds to vitamin D, which has a local anti-inflammatory response and simultaneously induces the production of decidual growth factors for successful pregnancy. Activated T- and B-lymphocytes have the vitamin D receptors and therefore 1,25(OH)2D is an effective modulator in the immune system. It is able to inhibit the proliferation of Th1 and to restrict the production of such cytokines as interferon-gamma (IFN-γ), interleukin-2 (IL-2), and tumor necrosis factor-alpha (TNF-α). In addition, vitamin D is able to induce cytokines of Th2 that have the protective effect on  pregnancy.

Conclusion. Adequate vitamin D intake is important for the successful conception and prolongation of pregnancy, as well as for the health of the fetus and newborn.

Journal of obstetrics and women's diseases. 2018;67(3):4-19
Possibilities for prediction and prevention of preeclampsia in women with diabetes mellitus
Kapustin R.V.

Based on the analysis of literature data, the role and serum levels of the main angiogenic (placental growth factor (PlGF)) and antiangiogenic vascular factors (endoglin (sENG), soluble fms-like type 1 tyrosine kinase (sFlt-1)) have been assessed in pregnant women with different types of diabetes mellitus (DM) in both the plasma and placenta. We evaluated the effectiveness of administration of low doses of acetylsalicylic acid for preventing preeclampsia in diabetic pregnancy. In addition, the effectiveness of using the sFlt-1/PlGF and PlGF/sENG ratios as possible test systems for prediction of the complication in this patient population was evaluated. It has been found that the synthesis of the studied biomarkers fails in the diabetic pregnancy, with the expression levels of sENG and sFlt-1 increased and PlGF reduced. However, the insufficient research does not allow us to make unambiguous conclusions about the practical validity of the evaluation of the plasma content of these vascular factors and their ratios for the preeclampsia prediction in pregnant women with DM. The presented data on acetylsalicylic acid administration to these women are also controversial. Given the high incidence of adverse perinatal outcomes associated with DM during pregnancy, an additional assessment of the prognostic risk model for the development of preeclampsia and the appropriateness of aspirin administration is needed. Therefore, further randomized studies are required to address this issue.

Journal of obstetrics and women's diseases. 2018;67(3):20-29
Gas chromatography-mass spectrometry based metabolomics of urine steroids in women with different phenotypes of polycystic ovary syndrome
Matyushenko M.V., Vorokhobina N.V., Velikanova L.I., Kovalyova Y.V.

This article presents an analysis of the metabolism of androgens, glucocorticoid hormones, and progestins obtained  by gas chromatography-mass spectrometry in 56 women with obesity and hyperandrogenia in comparison with 23 women with alimentary-constitutional obesity and 25 healthy women. An increase in urinary excretion of androsterone, 16-oxo-androstenediol (16-oxo-dA2), and α-tetrahydrometabolites of cortisone and corticosterone has been established in 25 women with polycystic-altered ovaries according to ultrasound, with urinary excretion of dehydroepiandrosterone (DHEA) and its metabolites (dA2-17β, 16β-DHEA, 16-oxo-dA2, and androstentriol), α- and β-metabolites of glucocorticoids and androstenedione, and 5-en-pregnans increased in 31 women without signs of polycystic ovaries according to ultrasound. A decrease in the tetrahydrocortisol/tetrahydrocortisone ratio was found in women with polycystic ovaries, indicating a decrease in the activity of 11β-hydroxysteroid dehydrogenase type 1. Evidence for the increased 5α-reductase activity was obtained in women with different phenotypes of polycystic ovary  syndrome.

Journal of obstetrics and women's diseases. 2018;67(3):30-37
The condition of mammary glands in women with diabetes mellitus type 1
Musina E.V., Kogan I.Y., Borovik N.V.

Background. The pathogenesis of diabetic mastopathy is unknown. It is assumed that one of the important factors in the development of this disease may be hyperglycemia.

The aim of this study was to evaluate the clinical manifestations and echographic features of the mammary gland structure in women with diabetes mellitus type 1.

Materials and methods. The three groups of women were examined: group 1: women with type 1 diabetes, with the onset of the disease before menarche (n = 58); group 2: women with type 1 diabetes, with the onset of the disease after menarche (n = 56); group 3: women with fibrocystic mastopathy, without diabetes mellitus type 1 (n = 79). Mastalgia was evaluated using the visual analogue scale. The ultrasound examination of mammary glands was performed on day 5 to 7 of the menstrual cycle.

Results. The patients of all groups complained of mastalgia. Mammary gland ultrasound revealed that the thickness of the glandular tissue in patients of the first group was significantly less than in the second and third group. The diameter of the milk ducts was also significantly different in patients in each study group. In the group of patients with fibrocystic mastopathy without diabetes mellitus type 1, the tissue echogenicity is average in 41.8% of subjects, with it elevated in 58.2% of individuals. Moreover, in groups of patients with diabetes, 90% of subjects have increased echogenicity of breast tissue.

Conclusion. Diabetic mastopathy is characterized by a fibrotic echo version of the organ parenchyma, which can be caused by a violation of the mammary gland formation and function in patients with diabetes mellitus type 1.

Journal of obstetrics and women's diseases. 2018;67(3):38-43
The prevalence of congenital fetal anomalies for the past 5 years (2013-2017)
Nagorneva S.V., Prokhorova V.S., Shelaeva E.V., Khudovecova A.M.

This article presents the data on the prevalence of congenital fetal anomalies in our hospital population obtained for the past five years (2013–2017). We analyzed the changes in their structure and the timing of diagnoses for the anomalies. In addition, the comparison of our results with international data was performed and extremely rare anomalies were described.

Journal of obstetrics and women's diseases. 2018;67(3):44-48
Hypothyroidism and early fetal demise
Olina A.A.

Background. The study is devoted to the evaluation of thyroid status in patients with early fetal demise.

The aim of the study was to assess the prevalence of hypothyroidism, including its subclinical forms, in patients with early fetal demise.

Materials and methods. It is an observational “case-control” retrospective study. Group I is represented by first-pregnant women with physiological on-time delivery of the healthy child (375 people). Group II consisted of 375 women who had had an episode of early fetal demise for up to 14 weeks. Laboratory and instrumental methods included assessment of TSH and anti-TPO antibodies levels and ultrasound imaging of the thyroid gland.

Results. Given TSH levels > 2.5 mU/L, the diagnosis of subclinical hypothyroidism was established in 13.1% of patients in group I and 26.4% in group II. In patients with repeated early fetal demise, the morbidity reached 48.4%.

Conclusion. Hypothyroidism can be recognized as a risk factor for early fetal demise (both the first and subsequent episodes) based on the odds ratio calculation. The odds ratio was 2.48 for early fetal demise in the presence of subclinical hypothyroidism and 2.15 for repeat episodes.

Journal of obstetrics and women's diseases. 2018;67(3):49-54
Vaginal apical and anterior reconstruction using ultralight weight mesh: two-year follow-up
Shkarupa D.D., Kubin N.D., Popov E.N., Shapovalova E.A., Kovalev G.V., Pisarev A.V.

Introduction. Anterior and apical prolapse is the most common type of pelvic organ prolapse. The insufficient  effectiveness of native tissue repair in the pelvic organs leads to the search of new methods of the pelvic floor reconstruction.

Objective. The current analysis was undertaken to evaluate the efficiency of the use of the Pelvix anterior mesh system (Lintex) with sacrospinous fixation of the apex in the treatment of anterior and apical prolapse.

Methods. This study involved 150 women suffering from anterior-apical prolapse (stages III and IV). Reconstruction with the use of the mesh was performed in all the patients. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, and validated questionnaires (PFDI-20, PFIQ-7, PISQ-12) were used. All the listed parameters were determined before the surgery and on follow-up visits in 1, 6, 12, and 24 months after the treatment.

Results. Mean operation time was 47 minutes. No cases of intraoperative clinically significant bleeding were reported. Anatomical cure rate (< stage II / asymptomatic stage II, according to the Baden-Walker system) at 12 months was found to be 94.4%, and at 24 months — 92.7%. Within the first month of follow-up, de novo stress urinary incontinence and de novo urgency occurred in 8.0% and 7.2% of patients, respectively. Statistically significant (p < 0.05) improvement in uroflowmetry parameters and decreased post-voiding urine volume were achieved after the surgery and did not change by 24 months. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period.

Conclusion. The use of the Pelvix anterior mesh system in the surgical correction of the anterior and apical prolapse is a safe uterus-sparing technique. At two-year follow-up, it provides a high anatomical efficiency, normalizes urodynamic parameters and improves quality of life.

Journal of obstetrics and women's diseases. 2018;67(3):55-63
Molecular-genetic background of endometriosis: diagnostic potential of heritable and expressed factors
Marzhevskay V.V., Prisyazhnaya T.S., Zhamoydik V.I., Berlev I.V., Malek A.V.

Endometriosis (EM) is a common disease in women of reproductive and perimenopausal age, characterized by the formation of ectopic foci of endometrial proliferation. The pathogenesis of the disease is multifactorial and has not been fully studied. Non-invasive examination methods have relative diagnostic value; therefore, current therapeutic approaches frequently do not provide a complete recovery. This situation determines the interest in studying the molecular and genetic background of EM and in searching for new diagnostic and prognostic markers.

In this review, we briefly discuss the prevailing theories of EM etiology, taking into consideration modern scientific concepts. A separate chapter highlights the data of the genome-wide associative studies (GWAS) that indicate the possibilities of involving a number of genes in the pathogenesis of EM (WNT4, CDKN2BAS, FN1). The main part of the review is focused on the analysis of the gene expression studies comparing the ectopic and eutopic endometrium of women with EM. Considering the clinical significance, the results of three studies comparing expression profile of the eutopic endometrium of healthy women versus patients with EM are presented in detail. In conclusion, the prospects of the development and clinical application of heritable and expressed EM markers are assessed.

Journal of obstetrics and women's diseases. 2018;67(3):64-73
The physiological role of vitamin D and the significance of its deficiency in the pathogenesis of climacteric syndrome
Morozova Y.E., Tarasova M.A.

This literature review summarizes data on the physiological role of vitamin D in women during menopause. We discuss the peculiarities of climacteric syndrome affected by vitamin D deficiency, including the impact of the vitamin on the central nervous system and its role in cognitive and affective disorders. The necessity of vitamin D therapy to prevent pathologies associated with menopause is highlighted.

Journal of obstetrics and women's diseases. 2018;67(3):74-82
The Influence of hormonal therapy on bone tissue: myths and reality
Shalina M.A., Yarmolinskaya M.I., Abashova E.I.

The paper presents a review of the current literature on the impact of estrogen, progesterone, and estrogen-progestin drugs (combined oral contraceptives, drugs for menopausal hormone therapy), thyroid, and glucocorticoid hormones on bone tissue. In this review, we discuss the pathogenetic mechanisms of the effects of various bioactive compounds on bone, and the results of domestic and foreign research.

Journal of obstetrics and women's diseases. 2018;67(3):83-94

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