Bychkova I. Optimization of diagnostics and tactics of management of pregnant women with various clinical-pathogenetic variants of gestational diabetes mellitus.

The work deals with the course of pregnancy and delivery in women with gestational diabetes mellitus and is directed on improvement of diagnostics and tactics of management of pregnant women with this disease. The clinical and statistical analysis of the course of pregnancy and delivery at women with various classes of gestational diabetes mellitus is carried out. It is established that screening-positive women without gestational diabetes mellitus are also belong to the group of risk of development of perinatal complications. It is established that the disease incidence is about 1,2 %. Absence of efficiency of screening which is based on distributions on risk factors is proved and necessity of universal screening testing of all pregnant women is ascertained. The data that diagnostic procedure can be reduced to one step, two-hour oral glucose tolerance test is obtained. Mechanisms of development of a gestational diabetes mellitus by detecting the levels of insulin and counteracting hormones, detection of antibodies to components of pancreatic islet cells are investigated. Direct communication between the levels of placental lactogen and frequency of such complications of pregnancy, as macrosomy, polyhydramnion, fetal distress is established. It is defined that the most informative vessels for investigation of fetal condition at pregnant women with gestational diabetes mellitus are uterine arteries, ductus venosus, middle cerebral and renal arteries of the fetus. Possibilities of improvement of management tactics of pregnant women with gestational diabetes mellitus by separation of four clinical-pathogenetic variants which differ on time of appearance and on way of compensation are resulted.