Aim: to summarize new data regarding the effectiveness of nutritional support during pregnancy.Materials and Methods. A search for publications was carried out in the PubMed/MEDLINE, Scopus, Web of Science, RSCI databases by retrieving queries for the following keywords: nutritional support, pregnancy, micronutrients, vitamins, macronutrients, without language restrictions. 71 sources with full text access were selected for analysis.Results. Nutritional status during pregnancy markedly impacts on mother's and neonate’s health. During pregnancy, requirements for macro- and micronutrients increase to maintain maternal homeostasis and support fetal growth. Increasing calorie intake in general female population demonstrates modest effects on pregnancy and fetal outcomes, whereas for pregnant women in poor income countries it results in no long-term benefits for children by assessing their anthropometric parameters and neurocognitive development. Despite the lack of conclusive evidence, in many countries sensible calorie restriction during pregnancy is recommended. Some micronutrients are vital for mother and fetus, because their deficiency is accompanied by increased risk of adverse pregnancy outcomes. For instance, folic acid deficiency is associated with the risk of developing fetal neural tube defects, iodine deficiency is coupled to the risk of emerging pediatric intellectual development disorders associated with congenital hypothyroidism, and calcium deficiency is related to a high risk of maternal hypertensive disorders. Therefore, micronutrient supplementation represents a technology with good potential in fighting for maternal and child health. Nonetheless, despite some advances in understanding nutritional support in pregnant women, many studies provide controversial data substantiating a need to conduct further investigations.Conclusion. Overall, recent year research confirms that the supplementation of micro- and macronutrients during pregnancy is an effective tool for “fetal programming” allowing to impact on maternal and fetal health. At the same time, an analysis of the literature showed a significant lack of research in the field of creating individual nutrition programs and nutritional support for pregnant women belonging to different segments of the population, living in different geographical regions, etc.

ИСХОД КРАЙНЕ ТЯЖЕЛОГО ТЕЧЕНИЯ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ

РОЛЬ СЕРДЕЧНО-СОСУДИСТОЙ КОМОРБИДНОСТИ В РАЗВИТИИ НЕБЛАГОПОЛУЧНЫХ ИСХОДОВ SARS-COV-2 В СТАЦИОНАРЕ III УРОВНЯ1 Кузбасская областная клиническая больница имени С.В

The article summarizes the current knowledge on epidemiology, pathophysiology, and management of patients with peripartum cardiomyopathy. The incidence of peripartum cardiomyopathy varies and largely depends on the geographic region. The overall mortality reaches up to 4-28%. Risk factors for developing peripartum cardiomyopathy include multiple pregnancies and multiple births, family history, smoking, diabetes mellitus, hypertension, preeclampsia, poor nutrition, older or adolescent maternal age, and long-term treatment with beta-adrenergic agonists. Genetic factors play the leading role in the pathophysiology of peripartum cardiomyopathy. It is generally confirmed by family history and the incidence variation depending on the geographical region. The pathogenetic role of vasoinhibin, an isoform of prolactin, is described. Vasoinhibin has antiangiogenic, proapoptotic, proinflammatory, and vasoconstrictor effects. The important role of an imbalance between angiogenic and antiangiogenic factors is discussed. There are no guidelines for obstetricians and gynecologists on the management of pregnant women, parturient women, and postpartum women. One of the reasons is the absence of evidence. An urgent cesarean section is indicated if the pregnant woman has acute heart failure and requires inotropic support and/or invasive therapy. However, 2018 ESC Guidelines for the Management of Cardiovascular Diseases during Pregnancy recommend vaginal delivery in these patients.