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Background: High-performance parallel next-generation sequencing (NGS) allows for identification of various maturity-onset diabetes of the young (MODY) subtypes also during pregnancy. As this method is expensive and time-consuming, it has proposed to use various predictors for the diagnosis of mutation in the hexokinase (GCK)/MODY2 gene, helping to select the patients for subsequent molecular genetic testing. Hyperglycemia due to MODY2 is commonly newly diagnosed during pregnancy; therefore, there is a search for factors specific to this mutation in pregnant women.Aim: To evaluate blood glucose variability in pregnant women with newly diagnosed hyperglycemia at early gestation and to determine the threshold value of the glycemic variability coefficient for pregnant women with a mutation in the GCK/MODY2 gene.Materials and methods: This observational single center study included 41 pregnant women with newly diagnosed early hyperglycemia (not meeting the criteria for manifest diabetes mellitus). Molecular genetic testing was performed in all of them. According to its results, they were retrospectively categorized into two groups: with early gestational diabetes mellitus (GDM, no mutations) and with hyperglycemia related to a mutation in the GCK/MODY2 gene. A comparative analysis of glycemic variability in the two groups was performed. Sensitivity and specificity of the cutoff value for the coefficient of variability as a diagnostic marker of MODY2 were also calculated.Results: The pregnant women with GDM had significantly higher age and body mass index (BMI) than those with MODY2 (pConclusion: The calculated sensitivity of 65% and specificity of 65.4% for the CV of 20.8 do not allow for its use as an independent selection criterion for subsequent confirmation of MODY2. However, its combination with the A.J. Chakera criteria (BMI2 and fasting glucose≥5.5 mmol with 68% sensitivity and 96% specificity) allows to clarify the category of pregnant women with newly detected early hyperglycemia, to whom the search for mutations in the GCK gene should be recommended.

Background: The course of pregnancy and delivery in patients with diffuse toxic goiter (DTG) is often complicated by preeclampsia, fetoplacental insufficiency, placental abruption and associated with higher maternal and perinatal mortality. Aim: To study particulars of fetoplacental complex functioning in DTG. Materials and methods: We assessed pregnant patients with DTG (n = 92) and their newborns (n = 94). By the time of delivery, 86 of patients were clinically and biochemically euthyroid. Functions of fetoplacental complex (by levels of placental lactogen, α-fetoprotein, estriol, progesterone and cortisol) were assessed by radioimmune and immunoenzyme assays. Fetometrical parameters of fetuses were studied by ultrasound method. Complex assessment of placentas was done by light and electronic microscopy. Results: Eighty seven (94,6%) patients with DTG had combined complications of pregnancy. The most frequent were: the threat of termination of pregnancy, in 68 (73.9%) of cases, low placenta placement, in 23 (25%), anemia, in 56 (60.9%), pre-eclampsia, in 56 (60.9%). In 59 of patients (64.1%), fetoplacental insufficiency was diagnosed, with predominance of strain or exhaustion reactions. Critical status of fetoplacental complex was found in pregnant patients with uncontrolled DTG and duration of control of less than 20 weeks, as well as in pregnant patients with DTG relapses. The values of main hormones (placental lactogen, α-fetoprotein and progesterone) were below 10th percentile. According to the results of the ultrasound assessments, fetuses from mothers with DTG during gestation demonstrated decrease of the majority or percentile parameters, such as biparietal cranial size, fetal femoral length, abdomen diameter, that was especially prominent in the groups with relapsing DTG. Eighty eight of 94 newborns (93.6%) were born full-term. In total, every third baby (29.3%) had some degree of intrauterine developmental delay at birth. Among the cases with controlled DTG in mothers, there were 21.2% of such babies, whereas among those with DTG relapses, 40%. There was an association between the length of DTG control during pregnancy and mass and body parameters of newborns: the shorter was duration of DTG control during gestation, the higher was the risk of low birth weight fetuses (р < 0.05). Histological assessment of placentas from DTG patients showed changes of endothelial microlandscape with sprouting of cell plasmolemma, blood cell adhesion and fibrin deposition. In 86% of placentas there were stasis, sludge formation and thrombosis in cord vessels. Conclusion: Pregnancy starting during uncontrolled DTG is typically associated with primary placental insufficiency that is morphologically characterized by profound metabolic abnormalities (stromal fibrosis, immaturity of the villous tree, blood flow abnormalities and ischemia). Morphological and functional placental abnormalities correlated with duration of uncontrolled DTG and lead to high rate of intrauterine developmental delay.

Background: In the last years, an increase in numbers of pregnant patients with type 2 diabetes mellitus (T2DM) has been observed. Nevertheless, obstetricians/gynecologists and endocrinologists are not sufficiently aware of this problem. Aim: To analyze specific features of pregnancy course and outcomes in female patients with T2DM. Materials and methods: We performed a retrospective and prospective analysis of specific characteristics of pregnancy course and outcomes in 70 females with T2DM who were seen from 2008 to 2013. These 70 patients delivered 72 babies (including two twins). Results: Seventeen (24.3%) patients in their past history had perinatal losses or disability of babies. 81.4% of patients were obese. Twenty seven (38.6%) patients had arterial hypertension. Thirty (41.3%) patients had good diabetes control pre-pregnancy, whereas others were sub-optimally or poorly controlled. At trimester I, 45 (64.3%) of patients were treated with oral hypoglycemic agents. Thirteen (18.6%) of patients were hydramniotic and 4 (5.7%) were olygoamniotic. Mild gestosis was observed in 12, moderate, in 10 and severe, in 2 patients. Preterm delivery was performed in 9 (12.9%) of patients, among them in 5 cases due to a critical state of the fetus. Natural deliveries occurred in 34 (48.6%) of females. Deliveries of big fetuses were observed in 10 (13.9%) of cases. Thirty four (47%) of newborns had diabetic fetopathy, 4 (5.5%) had birth trauma. The rate of congenital abnormalities was 9.7%. All patients whose babies had congenital abnormalities, had concepted while taking sensitizers, and 7 of them were poorly controlled by that time. Any unfavorable perinatal outcome was registered in 32%. Conclusion: Female patients with T2DM have a high frequency of unfavorable perinatal outcomes (birth defects, disability in babies, prolonged intensive care in the neonatal period), and among complications of pregnancy, a high rate of gestosis (in particular in patients with baseline arterial hypertension). Improvement of perinatal and obstetric outcomes would require an optimization of management of such patients. Thus, it is reasonable to establish a multi-disciplinary team of specialists, including obstetrician/gynecologists, endocrinologists, internists and neonatologists, on the bases of centers for perinatal care or multifield hospitals with big in-patient department of obstetrics.

Gestational diabetes mellitus (GDM) is hyperglycemia that is first detected during pregnancy and does not meet the criteria for manifest diabetes. The incidence of GDM worldwide varies from 1 to 14% and that in Russia is as high as 4%. Hyperglycemia during pregnancy is associated with the development of preeclampsia, the birth of a big baby, emergency cesarean section, birth trauma, and neonatal hypoglycemia. The fact that there is no well-organized screening for GDM in our country leads to that the diagnosis of this condition is delayed for 4-20 weeks in 50-60% of cases. The risk group distribution of pregnant women leads to the diagnosis of GDM only in 50% of cases. At the same time, pregnancy is accompanied by physiological insulin resistance so the latter itself is a clinically important risk factor for carbohydrate metabolic disturbances. The Hyperglycemia and Adverse Pregnancy Outcomes (HYPO) study has indicated that the previously used diagnostic criteria for GDM require reconsideration. There is a need for uniform standards for the diagnosis and treatment of carbohydrate metabolic disturbances during pregnancy. The concepts "diabetes mellitus (DM)" and "manifest (new-onset DM during pregnancy" and directly "GDM" require clear clinical and laboratory definitions. Furthermore, GDM is a risk factor for obesity, type 2 DM and cardiovascular diseases in the mother and her offspring in future.

Йоддефицитные заболевания (ЙДЗ) являются серьезной проблемой здравоохранения практически во всем мире. Наиболее тяжелые из них напрямую связаны с нарушениями репродуктивной функции или развиваются перинатально: врожденные аномалии, эндемический кретинизм, неонатальный зоб, гипотиреоз, снижение фертильности. Широкое внедрение на всей территории России программы антенатальной и постнатальной йодной профилактики, подразумевающей прием беременными и кормящими женщинами препаратов йода в суточной дозе 200 мкг/сут, позволит значительно снизить патологию беременности и улучшить психическое и физическое здоровье подрастающего населения.