Adipokinesand Ghrelin Rolein Regulation of Ovarian Function in Obesity

There is a great worldwide trend in the incidence of obesity, which is increasing with each passing year among all populations, including women of reproductive age. Given the impressive list of diseases associated with obesity, as well as the negative inverse correlation of the severity of obesity with fertility, this problem is global not only in the social sphere, but it also becomes demographically significant.Along with other pathogenetic mechanisms leading to persistent anovulation, an imbalance in adipokine production by adipose tissue can also serve as one of the important links in the development of reproductive dysfunction. Despite apparent interest in this topic, a large number of previously discovered adipokines are still not studied. Among adipokines, the effects of adiponectin and leptin on reproductive function are best known. Alterations in adiponectin and leptin levels can affect hypothalamic-pituitary-gonadal signaling, folliculogenesis, oogenesis and steroidogenesis. In addition, leptin is involved in the initiation of puberty, regulation of the menstrual cycle, and changes the balance between proliferation and apoptosis in ovarian cells. The leading causes of reduced fertility, infertility, and IVF failure in obese patients are mechanisms that promote the formation of chronic anovulation, delay the maturation of oocytes, reduce their quality, and/or lead to changes in endometrial susceptibility. These effects can be caused by an imbalance in the concentrations of leptin and adiponectin (leptin excess and adiponectin deficiency), lead to endometrial dysfunction, disruption of implantation and early embryogenesis. These changes, in turn, can affect just as the likelihood of spontaneous conception, so the effectiveness of assisted reproductive technologies and subsequent gestation.Thus, the study of potential pathogenetic pathways of fertility regulation in obesity, one of which is the subject of this review, is an important area for further study

THE PREVENTION, DIAGNOSIS, AND TREATMENT OF VITAMIN D AND CALCIUM DEFICIENCIES IN THE ADULT POPULATION OF RUSSIA AND IN PATIENTS WITH OSTEOPOROSIS (ACCORDING TO THE MATERIALS OF PREPARED CLINICAL RECOMMENDATIONS)

The paper presents data on the role of vitamin D and calcium in the function of many human organs and tissues. Lifestyle, dietary preferences, and insufficient physical activity contribute to the high prevalence of vitamin D and calcium deficiencies in the adult population of Russia, causing different diseases and abnormalities. The authors have worked out recommendations for the preventive use of vitamin D and calcium in healthy population, give consumption rates for these substances, and describe the clinical and laboratory signs of vitamin D deficiency and indications for screening. They also propose treatment regimens for vitamin D deficiency and depict the signs of intoxication inoverdose. Particular emphasis is laid on the place of vitamin D and calcium in the therapy of osteoporosis

Pneumonia in pregnant women with covid-19: Is it a new thrombotic microangiopathy in obstetric practice?

Thrombotic microangiopathies during pregnancy and puerperium are rare and, if undiagnosed, can be life-threating conditions for both the mother and the baby. The aim of this review article is to briefly describe clinical profile and highlight the clues for a correct diagnosis of pregnancy-related thrombotic microangiopathies. Of particular interest and important practical significance are the presented data on changes in the hemostatic system in patients with a new coronavirus infection COVID-19 through the prism of thrombotic microangiopathies

VITAMIN D I GESTATsIONNYE RISKI

В последние годы распространенность дефицита и недостаточности витамина D высока. Среди беременных она составляет от 37 до 79%. Известно, что дефицит витамина D ассоциирован с риском развития невынашивания беременности, преэклампсией, гестационного сахарного диабета, бактериального вагиноза, синдром задержки роста плода, с повышенным риском родоразрешения путем операции кесарева сечения. Целью настоящего исследования явилась оценка частоты встречаемости дефицита и недостаточности витамина D у беременных с бесплодием, невынашиванием, преэклампсией и гестационным сахарным диабетом. Материал и методы. Когортное ретроспективное и проспективное исследование, выполнено на базе ФГБУ «СЗФМИЦ им. В.А. Алмазова». Обследовано 800 беременных женщин с сентября 2013 г по март 2015 г, проживающих в Санкт-Петербурге и Ленинградской области. Средний возраст 29±2,1 лет, срок беременности 12-14, 24-36, 34-38 недель. Всем беременным произведен забор биообразцов крови с последующим определением уровня 25-гидрокси-кальциферола (25-OH-D) электрохемилюминесцентным методом на анализаторе Architect 2000. Результаты. В результате проведенного исследования установлено: недостаточность и дефицит витамина D выявлены у 100% женщин с бесплодием (в фолликулярной жидкости у 80% пациенток, в сыворотке крови у 100%). При угрозе прерывания беременности в I триместре дефицит витамина D в сыворотке крови выявлен у 47,9% беременных, недостаточность - у 22,9%, норма витамина D - у 29,2%. Частота выявления дефицита витамина D у беременных с преэклампсией составила 69,6%, недостаточности витамина D - 21,5%, нормального уровня витамина D -8,9%. При физиологической протекающей беременности дефицит витамина D обнаружен не был, у 18,5% женщин выявлена недостаточность витамина D, у 81,5% женщин - нормальный уровень витамина D. Связь между дефицитом витамина D и развитием гестационного сахарного диабеты установлена не была. Выводы. Таким образом, недостаточность и дефицит витамина D встречается у 100% женщин с бесплодием, у пациенток с невынашивания беременности дефицит и недостаточность витамина D встречается в 6 раз чаще, у беременных с преэклампсией в 5 раз чаще встречается низкий уровень витамина D. При физиологической протекающей беременности недостаточность витамина D выявлена лишь у 18,5% женщин, дефицит витамина D выявлен не был

Dozozavisimyy effekt vliyaniya potrebleniyakal'tsiya na fosforno-kal'tsievyy i kostnyyobmeny pri beremennosti

The influence of calcium intake during pregnancy on calcium and phosphorus metabolism, bone turnover and BMD in postpartum period was investigated in 35 healthy pregnant women. The control group included 40 healthy women of reproductive age. In women with the consumption less than 800 mg of calcium in the III trimester of pregnancy there was decrease of calcium excretion by the kidney. In both subgroups of pregnant bone turnover markers showed increased metabolism in bone tissue in 1,3-1,5 times in comparison with control group. Measurement of the BMD made on 4-6 day postpartum period. In the lumbar spine and distal forearm osteopenia was diagnosed in 2,5 and 1,5 times more frequently than in the control group (

OTsENKA VSTREChAEMOSTI ALLEL'NYKh VARIANTOV GENA RETsEPTORA KAL'TsITONINA U ZhENShchIN SO SNIZhENNOY MPK PRI GIPOESTROGENEMII

Проводилась оценка встречаемости генотипов и аллелей гена рецептора кальцитонина у женщин со сниженной МПК в постменопаузальном периоде и после овариоэктомии. Изучался полиморфизм данного гена в группах наблюдения в зависимости от скорости костного обмена при гипоэстрогенемии, которая оценивалась на основании концентрации дезоксипиридинолина и степени снижения МПК за 12 месяцев исследования. достоверной разницы в распределении аллельных вариантов гена кальцитонина у женщин с высокой и низкой скоростями костного обмена как в постменопаузальном периоде, так и после овариоэктомии не обнаружено. несмотря на ожидаемую связь гена рецептора кальцитонина с риском развития остеопороза в постменопаузальном периоде, нами не получено достоверных данных, указывающих на определяющую роль данного гена в формировании костных потерь как в постменопаузе, так и у женщин после билатеральной овариоэктомии

VENOUS THROMBOEMBOLISM IN RELATION TO OVARIAN HYPERSTIMULATION SYNDROME: AN APPROACH TO DETERMINING THE LOW-MOLECULAR-WEIGHT-HEPARIN DOSES AND ACTIVITY

Ovarian hyperstimulation syndrome (OHSS) is a relatively common complication of ovarian stimulation. The pathophysiology of OHSS is characterised by increased capillary permeability. As a consequence of this, there is a fluid shift into third-space causing hemoconcentration, it may contribute to hypercoagulable state, with increased riskof venous thromboembolism. The article presents modern data on prevention of thromboembolic complication in OHSS patients with special focus on dosage and duration of thromboprophylaxis

EFFECTS OF INSULIN-LIKE GROWTH FACTOR TYPE I ON BONE REMODELING IN PHYSIOLOGICAL PREGNANCY AND NORMAL LEVELS OF VITAMIN D

During pregnancy the levels of IGF-I increase and in III trimester exceed greatly the values of I trimester. Its significant increase is noted from 22-24 weeks of pregnancy. Correlation analysis revealed a moderate negative correlation between the level of IGF-I in II trimester and distal forearm BMD (r = -0,35, p<0,5). Also a moderate positive correlation between the level of IGF-I and a marker of bone synthesis osteocalcin in the II and III trimesters of pregnancy was revealed (r = 0,46, p <0,05 and r = 0,41, p<0,05, respectively). Conclusions: IGF-I effects bone remodeling of long bones during pregnancy. It is probable that under the influence of IGF-I synthesis of bone matrix is increased, which in the presence of low calcium intake may be associated with reduced BMD at these bone sites

A Randomised, Controlled Study of Different Glycaemic Targets during Gestational Diabetes Treatment: Effect on the Level of Adipokines in Cord Blood and ANGPTL4 Expression in Human Umbilical Vein Endothelial Cells

Our aim was to study the expression of adipokine-encoding genes (leptin, adiponectin, and angiopoietin-like protein 4 (ANGPTL4)) in human umbilical vein endothelial cells (HUVECs) and adipokine concentration in cord blood from women with gestational diabetes mellitus (GDM) depending on glycaemic targets. GDM patients were randomised to 2 groups per target glycaemic levels: GDM1 (tight glycaemic targets, fasting blood glucose < 5.1 mmol/L and <7.0 mmol/L postprandial, N=20) and GDM2 (less tight glycaemic targets, <5.3 mmol/L and < 7.8 mmol/L, respectively, N=21). The control group included 25 women with normal glucose tolerance. ANGPTL4 expression was decreased in the HUVECs from GDM patients versus the control group (23.11 ± 5.71, 21.47 ± 5.64, and 98.33 ± 20.92, for GDM1, GDM2, and controls; p<0.001) with no difference between GDM1 and GDM2. The level of adiponectin gene expression was low and did not differ among the groups. Leptin gene expression was undetectable in HUVECs. In cord blood, leptin/adiponectin ratio (LAR) was increased in GDM2 compared to controls and GDM1 (p=0.038) and did not differ between GDM1 and controls. Tight glycaemic targets were associated with normalisation of increased LAR in the cord blood. ANGPTL4 expression was downregulated in HUVECs of newborns from GDM mothers and was not affected by the intensity of glycaemic control