medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-449medsovet-8630Research ArticleДРУГИЕ ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИOTHER PROBLEMS OF ENDOCRINOLOGYРоль и место метформина в репродуктивном здоровье женщин: от прегравидарной подготовки до грудного вскармливанияThe role and function of metformin in women’s reproductive health: From pre-pregnancy preparation to breastfeedinghttps://orcid.org/0000-0001-6385-540XДемидоваТ. Ю.DemidovaT. Yu.

Демидова Татьяна Юльевна, д.м.н., профессор, заведующая кафедрой эндокринологии лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Tatiana Yu. Demidova, Dr. Sci. (Med.), Professor, Head of the Department of Endocrinology, Faculty of Medicine

1, Ostrovityanov St., Moscow, 11799

t.y.demidova@gmail.comhttps://orcid.org/0000-0002-6826-5924ТепловаА. С.TeplovaA. S.

Теплова Анна Сергеевна, ассистент кафедры эндокринологии лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Anna S. Teplova, Assistant of the Department of Endocrinology, Faculty of Medicin

1, Ostrovityanov St., Moscow, 11799

anna_kochina_@mail.ruhttps://orcid.org/0009-0009-8544-2767СтепановаЕ. В.StepanovaE. V.

Степанова Екатерина Вадимовна, студент международного факультета

117997, Москва, ул. Островитянова, д. 1

Ekaterina V. Stepanova, Student of the International Faculty

1, Ostrovityanov St., Moscow, 11799

ekaterina_stepanova_2001@list.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation202401112024016223229Copyright © Демидова Т.Ю., Теплова А.С., Степанова Е.В., 20242024Демидова Т.Ю., Теплова А.С., Степанова Е.В.Demidova T.Y., Teplova A.S., Stepanova E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8630

Нарушения углеводного обмена не только снижают качество жизни пациенток репродуктивного возраста за счет изменения регулярности менструации, ановуляции и других клинических проявлений, но еще и затрагивают этапы планирования беременности, влияют на течение беременности и играют важную роль в метаболических нарушениях в послеродовом периоде. Для женщин с избыточной массой тела, наличием инсулинорезистентности (ИР), а также имеющимися нарушениями углеводного обмена чрезвычайно важен осознанный подход к планированию беременности с поддержанием целевых показателей до наступления и на всем протяжении беременности. Особая важность ответственного подхода связана с тем, что нарушения гликемии как в сторону гипер-, так и гипогликемии ассоциированы с рисками со стороны самой пациентки и будущего ребенка. Инфертильность, невынашивание беременности, риск преэклампсии и эклампсии, а также высокий риск родового травматизма (в отношении как матери, так и ребенка) вследствие особенностей родов крупным плодом распространены среди пациенток с нарушениями углеводного обмена. Среди всех нарушений углеводного обмена у пациенток репродуктивного возраста наиболее часто встречаются такие, как преддиабет, гестационный сахарный диабет, сахарный диабет 2 типа, и все они ассоциированы с ИР. Отдельно можно выделить синдром поликистозных яичников, одним из основных патогенетических звеньев которого также является ИР. Использование метформина как препарата, направленного на снижение ИР, патогенетически обосновано в подобных ситуациях, однако, несмотря на представленные большим количеством исследований доказательства безопасности применения метформина, унифицированные рекомендации по дозировке, срокам и длительности приема метформина отсутствуют.

Disorders of carbohydrate metabolism not only reduce the quality of life of patients of reproductive age due to violations of the regularity of menstruation, anovulation and other clinical manifestations, but also affect the stages of pregnancy planning, affect the course of pregnancy and play an important role in the postpartum period. In overweight women, the presence of insulin resistance (IR), as well as existing disorders of carbohydrate metabolism, a conscious approach to pregnancy planning with maintaining targets before and throughout pregnancy is extremely important. The particular importance of a responsible approach is necessary due to the fact that glycemic disorders in both hyperand hypoglycemia are associated with risks on the part of the patient and the unborn child. Infertility, miscarriage, the risk of preeclampsia and eclampsia, as well as a high risk of birth injury (in relation to both mother and child) due to the peculiarities of childbirth with a large fetus are common among patients with impaired carbohydrate metabolism. Among all disorders of carbohydrate metabolism in patients of reproductive age, the most common are such as prediabetes, gestational diabetes mellitus, type 2 diabetes mellitus, all of which are associated with IR. Polycystic ovary syndrome, one of the main pathogenetic links of which is also IR, can be outlined separately. The use of metformin as a drug aimed at reducing IR is pathogenetically justified in such situations, however, despite the evidence of the safety of metformin presented by a large number of studies, there are no unified recommendations on dosage, timing and duration of metformin administration.

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The authors declare that there are no conflicts of interest present.