[Vitamin D and reproductive health].

Vitamin D insufficiency and deficiency in women with infertility is more common than in the population. However, we still do not know the exact mechanisms for the participation of vitamin D in the regulation of reproductive function. The purpose of this study is to analyze actual literature data on the role of vitamin D in the regulation of reproductive system and its influence on using of assisted reproductive technologies for the treatment of infertility. A search was carried out for literary sources published in the NSBI database PubMed, Medline, and others with a search depth of up to 20 years. 135 sources on this topic were studied, of which 54 were included in the analysis. The review presents data obtained in animal studies, in vitro and in clinical studies. Thus, the absence of vitamin D resulted in a dramatical decrease in fertility in both female and male rats and mice, due to the development of hypocalcemia. In vitro studies describe its involvement in the receptive transformation of the endometrium and in the regulation of the immune response during embryo implantation. However, clinical studies often show conflicting results. There is no unequivocal data on the effect of vitamin D levels on spermogram parameters, but a decrease in the pregnancy rate was shown when ovulation was induced in pairs, where a vitamin D deficiency was revealed in men. A meta-analysis published in 2017 showed a decrease in the pregnancy and live birth rate in women with low levels of vitamin D after the use of assisted reproductive technologies (ART). It was not possible to establish whether this decrease depends on oocyte quality or endometrium. There is an opportunity that the effect of vitamin D deficiency on fertility will not come with all forms of infertility. For example, in women with anovulation due to polycystic ovary syndrome, vitamin D deficiency is demonstrated to decrease pregnancy rate in ovulation induction cycles and in ART. Such relationship was not found in women with unexplained infertility.Thus, the role of vitamin D in the pathogenesis of infertility requires further study, as well as the possibilities of therapy in order to increase the effectiveness of infertility treatment methods and assisted reproductive technology programs.

[Diagnostic and treatment of subclinical hypothyroidism in pregnant and planning pregnancy patients: modern view of the problem].

There is no universal diagnostic and treatment strategy of subclinical hypothyroidism (SHT) in pregnant women and those who are planning pregnancy due to differences in population-specific and trimester-specific thyroid-stimulating hormone (TSH) reference values, influence of thyroid autoimmunity markers on pregnancy outcomes, adherence to fixed universal cutoff concentrations TSH in Russia and multidisciplinary team care with different treatment opinions involving. An absence of universal approach to SHT leads to excess treatment, financial and psychological burden on pregnant women.Up to American Thyroid Association (ATA) Guidelines 2017 and project of Clinical Guidelines of Russian Association of Endocrinologists 2019 a treatment strategy of SHT should be left up to the endocrinologist to choose. In our paper we systematize global scientific and clinical experience of planning and management pregnancies with SHT to help physicians to choose treatment option based on principals of evidence-based medicine.

The new combination of risk factors determining a high risk of gestational diabetes mellitus.

AIM: The aim of this study was to identify early markers of gestational diabetes mellitus (GDM) and to reveal the most significant of them. METHODS: A total of 548 pregnant women were screened for GDM between weeks 24 and 28 of gestation, as defined by International Association of Diabetes In Pregnancy Study Groups (IADPSG) criteria, in a retrospective case-control study. First trimester maternal fasting glucose, anthropometric parameters and blood pressure were obtained from medical records. Classification Tree Method was used to identify combination of early pregnancy risk factors that predict the highest risk of the development of GDM in later pregnancy. RESULTS: The combination of Body Mass Index (BMI) >38.6 kg/m² with, abdominal circumference >91.5 cm and fasting glucose >4.5 mmol/L was associated with a 13-fold increased risk of GDM as compared to women who do not have this combination of symptoms (OR 13.2 95% CI: 2.7-63.3, P<0.001). In women with BMI less than 38,6 kg/m ² the combination of fasting glucose >4.5 mmol/L, abdominal circumference >91.5 cm with the presence of polycystic ovary syndrome (PCOS) was associated with a 6-fold increased risk of GDM as compared with women who do not have this combination of symptoms (OR=7.6, 95% CI: 1.9-30.02, P=0.003). CONCLUSION: A higher BMI, abdominal circumference, fasting glycemia in the first trimester of pregnancy and the presence of PCOS predict increased GDM risk. Taking these combinations into consideration may facilitate identification of women at particular risk for GDM.