Elena G. Deryabina

Introduction. Gestational diabetes mellitus (GDM) is associated with an increased risk of adverse obstetric and perinatal outcomes. Self-monitoring of blood glucose using a glucometer reflects only individual measurements and may fail to detect short-term episodes of hyperglycemia and asymptomatic hypoglycemia. Continuous glucose monitoring (CGM) allows the glycemic profile to be assessed over time using integrated metrics, including time in range (TIR). However, the optimal target TIR values for pregnant women with GDM and their association with pregnancy outcomes remain insufficiently studied. Objective: to assess the impact of achieving the recommended glycemic ranges according to CGM data on adverse pregnancy outcomes in patients with GDM. Material and methods. A retrospective cohort study was conducted in 100 patients with GDM who were followed up at medical centers of the Sverdlovsk Region and used the FreeStyle Libre 2 CGM system during pregnancy. CGM metrics were calculated over two-week intervals (from 3 to 13 intervals, December 2024 — November 2025) from sensor placement to delivery. Time in range (TIR), time above range (TAR), and time below range (TBR) were assessed. Glucose ranges of 3.5-7.8 and 3.5-7.0 mmol/L were chosen as targets. Patients were divided into groups according to the presence of the studied pregnancy outcomes: preterm birth (Conclusion. In patients with gestational diabetes mellitus using the FreeStyle Libre 2 continuous glucose monitoring system, high time-in-range values and a low proportion of time below range were observed. No statistically significant associations were found between time in range or time above range and adverse obstetric or neonatal outcomes. However, a trend toward increased time below range was observed in patients with preterm birth, indicating the need for further investigation of the potential role of hypoglycemia in adverse pregnancy outcomes in larger cohorts.

Monochorionic multiple pregnancy complicated by transfusion syndrome (MCTP) is associated with higher maternal serum levels of both hCG and thyroid hormones. There are virtually no data on the clinical consequences of MCTP for the mother and fetus in this situation.Case report. A 32-year-old multiparous patient with monochorionic diamniotic twins with stage III MCTP was admitted to the Research Institute of Obstetrics and Maternity Care at 21-22 weeks of pregnancy with complaints of weakness, dyspnea at rest, tachycardia up to 180 bpm. There were no indications of thyroid disease. Antibodies against thyroid peroxidase and TSH receptors were not detected. TSH level 0.007, CT3 128 pmol/l, CT4 162 pmol/l. Thyroid ultrasound was unremarkable. To reduce the heart rate, beta-blocker therapy was started. Selective laser coagulation of placental anastomoses was performed in the volume of 19 AV, 4 AA, 2VV. Amnioreduction was 2500 ml. A 2-fold decrease in the hCG level was noted after 2 weeks, and after another 2 weeks, the hCG levels reached normal values for the period in multiple pregnancies. Within 2 weeks after the operation, the patient’s pulse normalized, shortness of breath and weakness decreased.Сonclusion. This clinical case demonstrated a change in the mother’s thyroid function in TTTS before and after laser therapy. In the differential diagnosis of causes of thyrotoxicosis in pregnant women, endocrinologists and obstetricians should consider hCG-mediated hyperthyroidism associated with TTTS, since this condition is not expected to resolve spontaneously until fetoscopic laser coagulation of placental anastomoses is performed.

Background. Gestational diabetes mellitus is becoming an increasingly serious public health problem. Gestational diabetes mellitus significantly increases the risk of future maternal prediabetes as well as serious short- and long-term maternal and neonatal complications, including pre-eclampsia, maternal cardiovascular disease and stillbirth, macrosomia, birth trauma, respiratory distress, hypoglycemia, hyperbilirubinemia, and obesity in the child. Diet is the first-line treatment for gestational diabetes mellitus, even if it should be combined with physical activity correction and insulin therapy. Each meal should contain slowly digestible carbohydrates, protein, mono- and polyunsaturated fats, and dietary fiber. Dietary fibers are components of food that the body cannot fully digest, so this type of carbohydrate is not used for energy purposes. However, they must be included in the human diet. Most people eat less than 20 g of dietary fiber per day, of which 8-10 g usually come from bread and other cereal products, about 2-3 g from potatoes, 5-6 g from vegetables and only 1-2 g from fruits and berries. In order to make up for the deficit of dietary fiber intake, food products are enriched with them. Insoluble dietary fiber added to cereal products – bran bread, bread made from whole grains. Soluble dietary fiber, such as inulin, which stimulates the growth of beneficial intestinal microorganisms, enriched dairy products (yogurt). The preventive and ameliorating effects of dietary fiber in relation to gestational diabetes mellitus are well documented in many studies. For example, it has been shown that women with the highest dietary fiber intake before pregnancy had a lower risk of developing gestational diabetes mellitus. Results. This review focuses on studies of the use of dietary fiber as an adjunct to dietary recommendations to improve glycemic profiles, and shows the role of viscous soluble fibers, including potential use of psyllium.

The present article contains the newest ant the most actual version of clinical recommendations “Gestational diabetes mellitus” of the Russian Ministry of Health. This document has been confirmed for the period from 2024 until 2026 year. Gestational diabetes mellitus is widely known as onset of hyperglycaemia during pregnancy that does not responds to criteria of manifesting diabetes mellitus (DM). The time of next revision is 2026 year or earlier if new evidentiary material appear. The present version of clinical recommendation has been created due to collaboration between Russian Association of Endocrinologists and Russian Society of Obstetricians and Gynecologists. The document is finally approved by scientific and practical Council of the Russian Ministry of Health.

In vitro fertilization (IVF) is an important treatment option for infertility in patients with polycystic ovary syndrome (PCOS). However, women with PCOS are at higher risk of adverse pregnancy outcomes and complications such as ovarian hyperstimulation syndrome (OHSS), gestational diabetes mellitus (GDM), and preterm birth. Factors influencing pregnancy outcome in patients with PCOS are still unclear and require further study. Objective. To identify features of the course of pregnancy and perinatal outcomes in patients with PCOS after transfer of thawed embryos in a cycle of hormone replacement therapy, depending on the type of gestagen. Material and methods. A retrospective study was conducted that included 105 patients who gave birth at 37—42 weeks of pregnancy, who became pregnant after transfer of cryopreserved embryos in ART programs. Inclusion criteria for patients: age from 20 to 45 years; anovulatory infertility (N97.0); presence of PCOS in accordance with the Rotterdam criteria; taking micronized progesterone or dydrogesterone to achieve secretory transformation and as luteal phase support (LPS). All patients were divided into two groups: Group 1 — 53 patients treated with micronized vaginal progesterone 600 mg/day; Group 2 — 52 patients treated with dydrogesterone 30 mg/day orally. The main outcome pregnancy measures were: live birth, obstetric complications: frequency of miscarriage, premature birth, GDM, preeclampsia, fetal growth retardation. Statistical analysis was performed using the χ-square and Mann-Whitney criteria, odds ratio. Differences were considered significant at p<0.05. Results. The obtained data on perinatal outcomes, including anthropometric characteristics of newborns, were comparable in both groups. The highest incidence of GDM was recorded in the second half of pregnancy in both groups. Pregnancy in women with PCOS after transfer of thawed embryos was complicated by GDM in 98 and 88% of cases (p=0.048), placental insufficiency in 21 and 12% of cases, fetal growth retardation in 4 and 12% of cases, gestational hypertension in 4 and 12% of cases, with an outcome in preeclampsia in 0 and 4% of cases in the micronized progesterone and dydrogesterone groups, respectively (p≥0.05). Patients with polycystic ovary syndrome after thawed embryo transfer who take micronized progesterone as a post-transfer support drug compared to dydrogesterone have a higher risk of GDM and insulin therapy OR=0.143 [CI:0.017—1.209] (p=0.042). Conclusion. In patients with PCOS during thawed embryo transfer in the HRT cycle, it is worth considering the advisability of using dydrogesterone to reduce the risk of GDM.

Background. Gestational Diabetes Mellitus (GDM) is a common disorder that is getting a special attention recently due to the unwanted outcomes that it leaves on the health of both the women and their offspring. New approaches are being applied in order to develop strategies that prevent GDM and its consequences on the metabolic and physiological state. One of the factors that have been thought to be involved in the pathology behind this disorder is the microbiome.Objective: to determine the current evidence regarding the association of the maternal microbiota composition with gestational diabetes mellitus and to discuss the possibility of the management of GDM using the microbiome.Material and methods. An extensive literature review was conducted using the MEDLINE database (PubMed) using keywords and filter: randomized controlled trial, meta-analysis, systematic review.Research results. This review summarizes the main data on the influence of microbiota composition and diversity on the occurrence and development of GDM. Although there were some inconsistencies among the results, a pattern of significant changes in the gut, oral, and vaginal microbiome of women with GDM was observed. It was found that the composition and diversity of gut microbiota were significantly associated with the occurrence and development of GDM. Specifically, the abundance of certain gut bacteria is associated with anincreased risk of GDM, while other changes in the microbiome may beassociated with improved insulin sensitivity. In addition, alterations in the gutmicrobiota may affect blood glucose control through a variety of mechanisms, including the production of short-chain fatty acids, activation of inflammatory pathways, and metabolism of the B vitamin group.Conclusion. We concluded a clear existing correlation between GDM and the microbial communities, where specific patterns of alterations in the microbiome was observed in the gut, oral and vaginal tracts of the pregnant women. These findings, although having some limitations, are promising and encouraging to develop strategies that target the human microbiome in order to develop novel therapeutic plans to treat or prevent GDM using next generation probiotics and parabiotics. Future studies should assess the outcomes and the efficacy of such therapeutic methods.

Background. Pregnancy represents a unique immunological and physiological period during which microbial communities can have a significant impact on both maternal health and birth outcomes. Hormonal, immunological, and metabolic changes during pregnancy influence the microbiome and clinical outcomes, potentially impacting the well-being of both mother and child.Objective: generalization of modern scientific concepts about the relationship between the composition of the mother’s microbiota during pregnancy and its complications, discussion of the possibility of predicting pregnancy complications using the microbiome.Materials and methods. An extensive literature review was conducted using the MEDLINE (PubMed) database as of December 2024 with the following keywords and filter: randomized controlled trial, meta-analysis, systematic review.Research results: Extensive research links the dominance of certain Lactobacillus strains to different pregnancy outcomes, with L. cripatus being the most favorable strain. Only by existing in a normal symbiotic relationship between the organism and the microbiome is it possible to maintain homeostasis. Any shift in the balance in this system leads to the growth of opportunistic flora, which in turn triggers a cascade of immunological and physiological disorders. GDM, PCOS, premature birth — these conditions have features of the vaginal microbiocenosis.Conclusion. The microbiome composition of the female reproductive tract and intestine is dynamic during pregnancy and is influenced by a number of factors. More evidence suggests that dysbiosis is associated with various adverse pregnancy outcomes. Knowledge of the microbiome composition has the potential to improve the accuracy of diagnosis, develop targeted interventions, and reduce the risk of perinatal complications.

Background. Glucagon-like peptide 1 (GLP-1) is an incretin hormone whose mechanism of action also includes a slight delay in gastric emptying (GE). Due to the prevalence of type 2 diabetes mellitus and obesity, GLP-1drugs are prescribed to many patients, including women of reproductive age who are also taking COCs. For oral contraceptives, malabsorption may result in ineffective pregnancy prevention.The purpose of this literature review was to review data from studies on the effect of GLP-1 agonists on oral hormonal contraceptives (COCs) and to analyze data on the safety of concomitant use of COCs and GLP-1 agonists.Methods. PubMed and ClinicalTrials.gov were searched for publications using keywords. A total of 3 clinical studies were selected for inclusion in the literature review.Results. Studies involving GLP-1 have not revealed a statistically or clinically significant difference in drug-drug interactions with COC drugs.Conclusion. This review compared the effects of currently available GLP-1 on COCs in three clinical studies. Due to the prevalence of type 2 diabetes and obesity, GLP-1 is likely to be prescribed to many patients, including women of reproductive age who are also taking COCs. These drugs may affect the pharmacokinetics of COCs. Changes in the area under the curve, maximum concentration, and time to maximum plasma concentration of oral drugs can be avoided by taking these drugs 1 hour after GLP-1.

Background. Diseases of the endocrine system in their mothers, namely gestational diabetes mellitus (GDM), have a significant impact on the increase in morbidity in newborns. The main adverse outcome for children of mothers with GDM is macrosomia, as prenatal exposure to hyperglycemia increases the risk and programs the offspring to develop diabetes and/ or obesity in adulthood.Objective. To summarize modern scientific ideas about the impact of GDM on immediate and long-term disorders of health and lipid metabolism in newborns and young children.Material and methods. An extensive literature review was conducted using the MEDLINE database (PubMed) using keywords and filter: randomized controlled trial, meta-analysis, systematic review.Research results. This review summarizes the main evidence on the impact of maternal hyperglycemia on the health of her child and provides new information on the role of GDM in lipid disorders in newborns and young children.Conclusion. Children born to mothers with GDM have an increased risk of developing obesity and impaired glucose tolerance from a very early age and throughout all periods of child-hood. Maternal hyperglycemia affects both during pregnancy and the rate of physical development of children in early life. These studies are important given that neonatal fat, rather than birth weight, is an important risk factor for the development of obesity later in life.to summarize modern scientific ideas about the effect of GDM on immediate and long-term disorders of health and lipid metabolism in newborns and young children.

Due to its effect on insulin resistance, ease of administration and favorable safety profile, metformin has been included in the recommendations of foreign medical communities for the management of pregnant women with hyperglycemia since 2008. However, in Russia, the use of any oral hypoglycemic agents during pregnancy is still contraindicated. However, recent studies demonstrate the safety and positive effects of metformin on pregnancy in patients with pregestational diabetes mellitus, polycystic ovary syndrome and gestational diabetes mellitus. In 2023, the Federal Service for Surveillance in Healthcare of the Ministry of Health of Russia updated the instructions for the medical use of Glucophage® and Glucophage®Long: pregnancy was excluded from the “Contraindications” section and moved to the “With caution” section. This resolution is intended to evaluate studies of the effectiveness and safety of metformin, as well as to study the experience of foreign colleagues and Russian legal aspects of prescribing metformin in the stages of preparation for pregnancy, during it and in the post-gravid period.