Vol 12, No 2 (2025)

The issue of obesity remains highly relevant both in Russia and worldwide, becoming increasingly acute each year. Bariatric surgery in women with obesity is associated with a number of positive effects, including improved fertility, a reduced risk of gestational diabetes and pre-eclampsia due to enhanced insulin sensitivity and normalization of glucose levels. However, the intrapartum and postpartum periods are associated with several challenges, including an increased risk of micronutrient deficiencies, development of dumping syndrome, anemia, and fetal growth retardation. Therefore, it is essential to develop individualized treatment plans for patients following bariatric surgery to prevent potential complications affecting both the mother and the fetus. Special attention should be paid to additional vitamin intake and individualized dietary planning, as these are important for the future child's health. Bariatric surgery is an effective treatment for obesity, but it should only be recommended when conservative approaches—such as dietary and lifestyle modifications, pharmacotherapy, and increased physical activity—fail to achieve sufficient weight loss. When choosing this method of obesity treatment, women should be informed about possible complications, postoperative metabolic peculiarities, and the necessity of their correction. It is also important to inform patients about postoperative rehabilitation and preconception care, which should last 12–18 months after surgery before planning a pregnancy. This review was based on a search in the PubMed database using the logical operator and a combination of the following keywords: pregnancy and bariatric procedures. This search yielded 111 results, 50 of which were relevant to the study topic. The types of publications included: article type, books and documents, clinical trial, meta-analysis, randomized controlled trial, review, and systematic review. An additional publication search was conducted using the eLibrary and PubMed databases, focusing on the following keywords: ожирение и репродуктивная система (obesity and reproductive system), ожирение и бесплодие (obesity and infertility), бариатрическая хирургия (bariatric surgery), осложнения бариатрической операции (bariatric surgery complications), морбидное ожирение (morbid obesity), and беременность после бариатрической операции (pregnancy after bariatric surgery). The review includes articles published over the past 10 years.

Premature ovarian failure is a complex and multifactorial condition, the main clinical sign of which is persistent or intermittent amenorrhea lasting for at least four months. This condition is diagnosed at an age of up to 40 years. The relevance of this article lies in a more detailed examination of the causes, pathogenesis, and key clinical symptoms of premature ovarian failure. Particular attention is given to early diagnosis in women of young and middle reproductive age in order to optimize management strategies in the context of reproductive goals, as well as to the current state of scientific research. The review highlights several emerging therapeutic approaches that have shown promising results, including platelet-rich plasma (PRP) therapy, exosome-based therapy, in vitro follicle activation, stem cell therapy, microRNA-based strategies, and mitochondrial-targeted therapy. These experimental treatment strategies aim to stimulate oogenesis and folliculogenesis by enhancing natural biochemical pathways (neo-oofolliculogenesis) and improving the ovarian microenvironment.

Endometrial cancer is a prevalent oncological disease closely linked to obesity and disturbances in carbohydrate and lipid metabolism. Current approaches to conservative treatment of endometrial cancer in young women aim to preserve reproductive function and include high-dose progestin therapy, which may further contribute to weight gain. The relationship between obesity and treatment efficacy in endometrial cancer is multifactorial and involves hormonal changes, chronic inflammation, metabolic disturbances, and alterations in the tumor immune microenvironment. A comprehensive weight management approach—including dietary interventions (such as ketogenic diet, intermittent fasting, and caloric restriction), regular physical activity, and behavioral therapy—has demonstrated significant improvements in tumor remission rates and pregnancy achievement. This review highlights the key mechanisms by which obesity contributes to the development and progression of endometrial cancer, discusses current weight management strategies, and outlines future research directions, including the study of metabolites, the gut microbiome, neural appetite regulation mechanisms, and the implementation of personalized approaches using artificial intelligence and wearable devices. Comprehensive weight management is becoming a priority area for improving treatment effectiveness and outcomes in patients with endometrial cancer who aim to preserve their reproductive function.

Background: The increasing number of infertile couples has led to the growing popularity of assisted reproductive technologies as a means of achieving desired pregnancy. It is known that assisted reproductive technologies are an independent risk factor for a serious pregnancy complication—gestational diabetes mellitus. The multifactorial and polygenic nature of gestational diabetes mellitus, as well as its high prevalence following in vitro fertilization, make this issue of particular interest for research.

Aim: To investigate the prevalence of gestational diabetes mellitus in pregnancies achieved through in vitro fertilization, its pathogenetic features, and possible risk factors.

Methods: Scientific publications from eLibrary and PubMed databases were analyzed, focusing on the prevalence, risk factors, and pathogenetic features of gestational diabetes mellitus after assisted reproductive technologies. Outpatient and inpatient medical records of 116 women with singleton pregnancies from 2018 to 2022 were analyzed retrospectively and prospectively. The main group included 77 (66%) patients with in vitro fertilization pregnancies and confirmed gestational diabetes mellitus; the reference group included 39 (34%) in vitro fertilization patients without gestational diabetes mellitus.

Results: The prevalence of gestational diabetes mellitus among pregnant women after in vitro fertilization is significantly higher than in the general pregnant population and, according to various sources, reaches up to 12.6%. Gestational diabetes mellitus is a polygenic multifactorial disease, with epigenetic influences acting as triggers in the presence of specific gene polymorphism associations. A high pregestational body mass index was identified as a risk factor for gestational diabetes mellitus after in vitro fertilization, whereas the number of in vitro fertilization attempts and the follicle-stimulating hormone to luteinizing hormone ratio did not significantly affect its development in this cohort. The etiology of infertility may be a risk factor for gestational diabetes mellitus according to some data, but in our study, no statistically significant differences were found between groups based on infertility cause (p > 0.05).

Conclusion: Understanding the pathogenetic features, identifying, and timely modifying potential risk factors for gestational diabetes mellitus among pregnant women following in vitro fertilization will allow for timely correction of carbohydrate metabolism disorders, as women with gestational diabetes mellitus are at high risk for pregnancy complications and the subsequent development of type 2 diabetes mellitus.

Background: Gestational diabetes mellitus increases the risk of adverse pregnancy outcomes for both mother and fetus. Hyperglycemia in gestational diabetes mellitus contributes to fetopathy, macrosomia, and increases the risk of type 2 diabetes, obesity, and hypertensive disorders. Lifestyle modifications in pregnant women with gestational diabetes mellitus can reduce these risks.

Aim: To assess the height and weight parameters of newborns born to women with gestational diabetes mellitus who achieved normoglycemic compensation.

Methods: A total of 119 newborns were assessed; they were born to mothers who had full-term, singleton pregnancies and delivered vaginally in cephalic presentation. To diagnose gestational diabetes mellitus, an oral glucose tolerance test was performed at 24–28 weeks of gestation. The pregnant women and their newborns were divided into two groups: the main group (n=31) with gestational diabetes mellitus confirmed by an endocrinologist based on reference venous plasma glucose levels, and the control group (n=88) with uncomplicated pregnancies and deliveries. To assess anthropometric conformity of newborns in the groups, INTERGROWTH-21st centile charts were used. Statistical analysis of the study results was performed using StatSoft software (Russia).

Results: The pregnant women with gestational diabetes mellitus strictly followed dietary therapy and maintained physical activity, which enabled them to achieve normoglycemic compensation. Deliveries in women with gestational diabetes mellitus occurred at 39–40 weeks, with no significant difference compared with the control group (p >0.05). The mean length of the newborns was assessed in three subgroups (47–50 cm, 51–54 cm, and ≥55 cm). In the first subgroup, the mean length was 48.7 cm in the gestational diabetes mellitus group and 49.6 cm in the group without gestational diabetes mellitus (p >0.05); in the second subgroup, it was 52.1 cm in both groups (p >0.05); and in the third subgroup, it was 56.0 cm and 55.2 cm, respectively (>0.05). Newborn weight was assessed across four subgroups (≤3000 g, 3050–3500 g, 3550–3950 g, ≥4000 g). In the first subgroup, the mean weight was 2790 g (gestational diabetes mellitus) and 2850 g (without gestational diabetes mellitus) (p >0.05); in the second subgroup, it was 3330 g and 3260 g (p >0.05); in the third subgroup, it was 3690 g and 3770 g (p >0.05); and in the fourth subgroup, it was 4110 g and 4120 g (p >0.05), respectively. The head circumference of newborns was 35 [33; 36] cm in the gestational diabetes mellitus group and 34.7 [33; 37] cm in the group without gestational diabetes mellitus (p >0.05).

Conclusion: Adherence to dietary therapy and moderate physical activity enabled normoglycemic compensation in pregnant women with gestational diabetes mellitus without using insulin. No differences were observed in the main anthropometric parameters of newborns from mothers with gestational diabetes mellitus compared with the control group representative of the general population. Term delivery and the absence of perinatal complications requiring early delivery indicate successful compensation of gestational diabetes mellitus.

Background: Between 40% and 80% of women over the age of 50 experience pelvic organ prolapse of varying clinical severity, often accompanied by stress urinary incontinence. With a growing trend toward abandoning synthetic meshes in pelvic surgery, the search for alternative treatment methods has become a relevant issue.

Aim: To assess the potential for correcting stress urinary incontinence and pelvic organ prolapse without using mesh implants.

Methods: A prospective clinical study included 70 women with varying degrees of pelvic organ prolapse. Patients with stage I prolapse according to the POP-Q classification were included only if they had concomitant complaints of stress urinary incontinence. These patients formed Group 1 (n = 24). Group 2 included patients with stage II–IV pelvic organ prolapse by the POP-Q with mandatory apical compartment descent (n = 46). Patients from each group were divided into subgroups. Subgroup 1A received transurethral injections of fillers, whereas subgroup 1B underwent conventional TVT-O sling placement. In Group 2, two types of surgery were performed according to subgroup assignment: in subgroup 2A, laparoscopic promontofixation of the cervical stump was carried out using a mesh-less technique (native tissues and suture material); in subgroup 2B, conventional laparoscopic sacrocolpopexy with polypropylene mesh was performed.

Results: In Group 1, 12 months after filler injection, clinical efficacy was sustained in 40% of patients, which was more than two times lower than in the mesh sling group (93%). With careful patient selection, fillers may reduce hospital workload by shifting a portion of stage I pelvic organ prolapse patients with stress urinary incontinence symptoms to outpatient care, while lowering the use of foreign implants. In Group 2, the anatomical success rate at 1 month was 92% in subgroup 2A (mesh-less) versus 90% in subgroup 2B (p = 0.265). Although 1-year recurrence rates were comparable between subgroups, long-term follow-up over 5–10 years is necessary for a comprehensive outcome assessment.

Conclusion: Given the minor advantages of various mesh implants in pelvic surgery, their high cost and increasing rates of intra- and postoperative complications have led to a trend toward alternative surgical approaches using autologous tissues and non-surgical injectable therapies in cases of stress urinary incontinence.

Premature isolated adrenarche is a diagnosis of exclusion that requires careful differential diagnosis and subsequent long-term follow-up to monitor for potential late complications (such as polycystic ovary syndrome, carbohydrate metabolism disorders, and cardiovascular diseases). Conditions that may mimic isolated adrenarche include central precocious puberty and congenital adrenal hyperplasia, both of which necessitate timely diagnosis and appropriate pharmacotherapy. However, in pediatric clinical practice, isolated forms of precocious puberty are more common and require ongoing monitoring to assess the risk of complications involving the carbohydrate metabolism, reproductive, and cardiovascular systems.

This article presents a clinical case of isolated adrenarche in a six-year-old girl. Her parents sought medical attention due to the appearance of terminal hair in the axillary region. On physical examination, dark, coarse terminal hair was observed in the axillary, pubic, and perilabial areas, without signs of hirsutism. Laboratory examination revealed increased dehydroepiandrosterone sulfate, whereas markers of congenital adrenal hyperplasia and central precocious puberty were excluded.

Based on the patient’s complaints, medical history, and laboratory and instrumental data, a diagnosis of isolated adrenarche was established. The condition was attributed to premature maturation of the adrenal zona reticularis. It was accompanied by increased dehydroepiandrosterone sulfate (as confirmed by laboratory tests), advancement of bone age by one calendar year, and clinical signs such as pubic and axillary hair growth. Comprehensive examination ruled out congenital adrenal hyperplasia, central precocious puberty, adrenal or gonadal tumors. No treatment was indicated in this case. However, regular follow-up is necessary, as scientific data indicate that girls with early adrenarche are at increased risk for developing certain conditions. Parents of children with this variant of precocious puberty should be counseled on the importance of long-term monitoring.