CC BY
5Репродуктивное здоровье
женщин после приема препарата: 4 % - 18,5 и меньше, 32 % - 18,5-24,9, 52 % - 25-29,9, 12 % - 30-34,9, 0 % - 35 и больше. После приема у 100 % женщин МЦ стал в диапазоне 27-35 дней, до приема - выходил за пределы нормы (более 38 дней); данные по обильности маточных кровотечений: до приема препарата: 4 % - скудные, у 28 % - обильные, 68 % - умеренные; после приема: 96 % - умеренные, 4 % - обильные. Аномальные маточные кровотечения отсутствовали «до» и «после» комплексного приема препарата «Дикироген» у 25 женщин. До приема препарата уровень глюкозы у 40 % человек был выше границы нормы, после приема препарата 100 % женщин показатели укладывались в норму. После приема препарата у 73 % женщин уровень тестостерона снизился, у 27 % - остался прежним.
THE IMPACT OF EARLY AND LATE GESTATIONAL DIABETES MELLITUS ON THE COURSE AND OBSTETRIC
AND PERINATAL OUTCOMES OF THIS PREGNANCY
Tkachenko A.S.
Ivanovo State Medical Academy, Department of Obstetrics and Gynecology, Medical Genetics, Ivanovo, Russia
Scientific supervisor: BatrakN.V., Cand. Sci. (Med.)
Relevance. Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnant women.
Every seventh child is born to a mother with some form of hyperglycemia during pregnancy, while 84 % of cases of newly diagnosed diabetes during pregnancy are associated with GDM.
GDM is a serious medical and social problem due to an increase in the frequency of complications and undesirable outcomes of pregnancy, the frequency of which depends on the time of detection of this disease.
Objective. To evaluate the impact of early and late gestational diabetes mellitus on the course and obstetric and perinatal outcomes of this pregnancy.
Materials and methods. A study of 77 pregnant women aged 22-46 years was conducted on the basis of antenatal clinics in Ivanovo for the period 2020-2022. Of these, 43 women made up group 1 with early GDM - diagnosed before 24 weeks, and 34 women made up group 2 with late GDM - diagnosed after 24 weeks.
As a research method, a self-developed questionnaire was used, including the study of the course and obstetric and perinatal outcomes of this pregnancy.
Results and their analysis. As a result of the analysis of the course of this pregnancy, it was found that in women of the 1st group, non-developing pregnancy up to 12 weeks (10.5 and 0 %; p < 0.01), threatening early pregnancy (44.7 and 3.1 %; p < 0.001) and late miscarriages (10.5 and 0 %; p < 0.01), placental insufficiency (30 and 6.3 %; p = 0.01), placenta previa (6.7 and 0 %; p = 0.04).
In addition, in women with early GDM, preterm birth (28.6 and 6.3 %; p < 0.05), antenatal fetal death (6.7 and 0 %; p < 0.05), diabetic fetopathy according to ultrasound data (6.25 and 0 %, p > 0.05). In women with late detection of GDM, moderate preeclampsia (10 and 12.5 %, p > 0.05).
When evaluating the method of delivery, no significant differences were found in the studied groups. However, clinically narrow pelvis (12.5 and 0 %; p = 0.04) and breech presentation of the fetus in combination with other factors (18.8 and 0 %; p = 0,01). Whereas in the 2nd group of women - weakness of labor activity (0 and 16.7 %; p = 0.02).
As a result of the analysis of anthropometric data, an increase in the weight (3256 and 3425 g; p>0.05) and body length (51.4 and 51.8 cm; p > 0.05) of newborns in women with late GDM was noted, however, these indicators did not were reliable.
Newborns born both to women with early and late detection of GDM equally needed transfer and treatment in other departments and hospitals.
Women of both groups equally rarely consulted an endocrinologist after delivery (14.3 and 19.4 %; p > 0.05), and therefore the diagnosis of GDM was withdrawn in a small number of those who applied (11.6 and 20 %; p > 0.05).
Discussion (conclusions). Based on the foregoing, it can be concluded that hyperglycemia detected before 24 weeks of pregnancy had the most adverse effect on its course and obstetric and perinatal outcomes (early non-developing pregnancy, threatened early and late miscarriages, placental insufficiency, placenta previa, preterm birth, antenatal fetal death).
Therefore, it is very important to raise the awareness of doctors and women about the possible development of GDM by organizing dispensary examinations at the preconception stage, during pregnancy and after childbirth with the active call of women to an appointment, which will help prevent the development of GDM.
