EARLY PROGNOSIS OF HYPOGALACTIA IN BREASTFEEDING MOTHERS: NEW OPPORTUNITIES FOR PRIMARY PREVENTION.

An increase in the hypogalactia frequency diagnosis in breastfeeding mothers is one of the world-spread medical and social problems and is especially high in women with risk factors of lactation disorders. Early estimation of risk factors creates opportunities for physicians to diagnose the lactation problem that mothers face and solve it. Aim - to identify and calculate prognostic criteria for determining the risk of hypogalactia in breastfeeding mothers and strategies to help women overcome them. Twenty-two factors that cause the most significant impact on the development of hypogalactia were selected, and their frequency was determined in 208 mothers with hypogalactia (group 1) and 388 mothers with normal lactation (group 2). The sequential Wald analysis, which compares the frequencies of distribution of traits in the study groups and determines their informativeness by calculating prognostic coefficients (PK) for different risk factors and estimating the individual risk of hypogalactia was used. The elder age of the breastfeeding mother (36-40 years and elder) and its lower educational level promoted hypogalactia. Low security of the mother was associated with hypogalactia (PC -1,4). It was also found that mothers engaged in heavy physical labor suffer from hypogalactia more often than employees. Mothers' return to work, have been reported as factors that influence breastfeeding. Occupational hazards (noise, dyes, vibration, lead soldering, dust factors) and bad habits caused hypogalactia (PC -5,4). Prenatal breastfeeding education has been shown to prevent hypogalactia. A burdensome obstetric history (PC -3,9), habitual miscarriage (PC-1,4), and female genital diseases worsen the prognosis of lactation. Extragenital pathology was characterized by negative PC of hypogalactia, especially rheumatic fever, compensated heart defect (PC -3,2), chronic cardiovascular insufficiency (PC -11,4), congenital heart disease (PC -11,4), obesity (PC -4,8), diabetes mellitus (PC -5,8). The time of the first application to the breast affected the mothers' milk production. The mathematical model of the individual prognosis of lactation in mothers contributes to the early detection of hypogalactia and the corresponding correction.

GENDER RELATED PECULIARITIES OF METABOLIC SYNDROME IN CHILDREN.

Metabolic syndrome (MеtS) is a combination of clinical and laboratory abnormalities that increase the risk of cardiovascular diseases and type 2 diabetes mellitus. Purpose - to detect and identify peculiarities of MetS and its criteria in children depending on gender. MetS was estimated in 89 (5.9%) children from 1520 examined children: in 39 (2.6%) girls and 50 (3.3%) boys (p>0.05) aged from 9 to 18 years. Children were selected for examination of anthropometric data, blood pressure, total cholesterol, HDL-C, LDL-C, triglycerides, fasting glucose and insulin, index HOMA-IR, glucose/insulin ratio and QUICKI. Heart rate variability (HRV) study and echocardiography were done. Diagnosis of MetS was provided according to IDF Consensus (2007). Abdominal obesity was diagnosed in all children with MetS. Boys had essentially more large body mass, height, body surface area, neck and waist circumferences, weight/height ratio than girls (p<0,001). Blood pressure in boys was higher than in girls, arterial hypertention in boys (72,0%) was diagnosed more often than in girls (46,2%). Insulin resistance was identified 1,5 falled more often in girls than in boys (p<0,05). Statistically significant difference in lipid metabolism in boys and girls was not estimated. According to HRV boys had higher activity of the autonomous nervous system than girls. Left ventricular (LV) myocardial mass and thickness of the LV posterior wall in boys were significantly larger than in girls that proved a higher risk of LV hypertrophy and concentric remodeling. Attention to gender differences of MetS must be paid and gender-specific strategies for the prevention of cardiovascular diseases and type 2 diabetes mellitus should be formulated.

THE PATTERN OF METABOLIC SYNDROME IN CHILDREN WITH ABDOMINAL OBESITY.

The aim - to identify and quantify MS criteria in children with abdominal obesity and to detect the most frequent MS patterns for their farther prognosis and treatment. Out of 1600 observed children 88 were found to be abdominally obese (waist circumference more than 90-th percentile according to age and gender). Children were divided into 4 groups: group 1 - 13 children with single abdominal obesity criterion, group 2 - 31 children with abdominal obesity and one MS criterion, group 3 - 28 children with abdominal obesity and 2 MS criteria, group 4 - 16 children with abdominal obesity and three MS criteria. Study consists of clinical examination, anthropometric data estimation - mass, height, neck, waist and hip circumference, calculating of body mass index, waist / hip ratio, body surface. Cholesterol, HDL-C, LDL-C, VLDL-C, TG, fasting glucose and insulin in the blood were estimated. HOMA-IR and FG/fasting insulin ratio were calculated by formulas. Comparisons were done by Student's T-test (for parametric data), Mann-Whitney U test (non-parametric data). The software was Statistica.10 and MS Excel. MS has increased along with the growth in the prevalence of abdominal obesity in children. The most often MS patterns in children were BP more than 130/85 mm Hg/carbohydrate metabolism discharge /high TG and BP more than 130/85 mm Hg /carbohydrate metabolism discharge/decreased HDL-C. Abdominally obese children should be screened early for MS pattern and treated according to it.