vestommВестник охраны материнства и младенчестваBulletin of maternal and child care3034-395XФГБУ «НИИ ОММ» Минздрава России10.69964/BMCC-2026-3-2-20-32vestomm-106Research ArticleОБЗОРЫREVIEWSГестационный сахарный диабет как фактор риска неполноценности рубца на матке (обзор литературы)Gestational diabetes mellitus as a risk factor for uterine scar defects (literature review)НестеровВ. Ф.NesterovV. F.

Нестеров Виталий Федорович — старший научный сотрудник, заведующий операционно-родовым отделением

ул. Репина, д. 1, г. Екатеринбург, 620028 

Тел.: +7 (343) 371-42-93; +7 (912) 246-02-60 

Vitaly F. Nesterov — Candidate of Medical Sciences, senior researcher, head of the obstetric department

1 Repina St., Ekaterinburg, 620028 

Phone: +7 (343) 371-42-93; +7 (912) 246-02-60 

dr.nesterov2014@yandex.ruhttps://orcid.org/0000-0002-5500-6296МальгинаГ. Б.MalginaG. B.

Мальгина Галина Борисовна — доктор медицинских наук, профессор, заслуженный врач РФ, ученый секретарь, ведущий научный сотрудник

ул. Репина, д. 1, г. Екатеринбург, 620028 

Телефон: +7 (343) 371-08-78 

Galina B. Malgina — MD, PhD, Doctor of Medical Sciences, Professor, scientific secretary, leading researcher

1 Repina St., Ekaterinburg, 620028 

Phone: +7 (343) 371-08-78 

galinamalgina@mail.ruhttps://orcid.org/0000-0001-5607-5093ПутиловаН. В.PutilovaN. V.

Путилова Наталья Викторовна — доктор медицинских наук, профессор, заведующий научным отделением антенатальной охраны плода

ул. Репина, д. 1, г. Екатеринбург, 620028 

Телефон: +7 (343) 371-08-78 

Natalya V. Putilova — Doctor of Medical Sciences, Professor, Head of the Scientific Department of Antenatal Fetal Care 

1 Repina St., Ekaterinburg, 620028 

Phone: +7 (343) 371-08-78 

putilova-1959@mail.ruФедеральное государственное бюджетное учреждение «Уральский научно-исследовательский институт охраны материнства и младенчества» Министерства Здравоохранения Российской ФедерацииРоссияFederal State Budgetary Institution “Ural Research Institute of Maternity and Child Care” of the Ministry of Health of the Russian FederationRussian Federation202630072026322032Copyright © Нестеров В.Ф., Мальгина Г.Б., Путилова Н.В., 20262026Нестеров В.Ф., Мальгина Г.Б., Путилова Н.В.Nesterov V.F., Malgina G.B., Putilova N.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.vestnikomm.ru/jour/article/view/106

Введение. В обзоре литературы представлены современные взгляды на патогенез неполноценности рубца на матке у пациенток с гестационным сахарным диабетом.Целью данного обзора явилось обобщение данных литературы о состоянии рубца на матке, особенностях родоразрешения и течения послеоперационного периода у пациенток с нарушениями углеводного обмена, в частности, с гестационным сахарным диабетом с позиций патогенеза данного осложнения.Материалы и методы. В обзор включены опубликованные данные за последние 25 лет. Поиск литературы проводился в базах данных Elibrary, Medline, Scopus, Web of Science, Google Scholar, PubMed, Wiley и Cochrane Library.Результаты. Частота родоразрешения путем операции кесарево сечение у пациенток с гестационным сахарным диабетом значимо превышает общепопуляционную. При этом нарушения углеводного обмена ухудшают процессы формирования рубца на матке путем усиления воспалительных процессов, ухудшения миграции адипоцитов из миометрия, формирования грубого соединительнотканого рубца. В основе этого лежат не только воспалительные изменения, но и нарушения обменных процессов на клеточном уровне, а также сосудистые нарушения вследствие эндотелиальной дисфункции. Гестационный диабет не является прямым противопоказанием к проведению естественных родов у пациенток с рубцом на матке, хотя риск разрыва матки у этой категории пациенток выше, чем у женщин без нарушений углеводного обмена. Необходимо тщательно взвесить спектр противопоказаний к индукции родов, в частности, макросомию и наличие ожирения у пациентки, риск нарушения сократительной деятельности матки, которые в совокупности ухудшают прогноз самостоятельных родов. В послеродовом периоде необходима персонифицированная профилактика воспалительных заболеваний и формирования неполноценного рубца на матке.Заключение. Анализ данных литературы показал, что большинство авторов учитывают нарушения углеводного обмена, как фактора риска неполноценности/ несостоятельности рубца на матке, однако, необходимы дальнейшие исследования с целью обеспечения безопасного для матери и плода родоразрешения пациенток с рубцом на матке после предшествующего абдоминального родоразрешения и гестационным сахарным диабетом.

Introduction. This literature review presents current views on the pathogenesis of uterine scar defects in patients with gestational diabetes mellitus.The objective of this review was to summarize the literature on uterine scar status, delivery characteristics, and the postoperative course in patients with carbohydrate metabolism disorders, particularly gestational diabetes mellitus, from the perspective of the pathogenesis of this complication.Materials and Methods. The review includes published data from the past 25 years. A literature search was conducted in Elibrary, Medline, Scopus, Web of Science, Google Scholar, PubMed, Wiley, and the Cochrane Library.Results. The rate of cesarean section delivery in patients with gestational diabetes mellitus is significantly higher than the general population. Furthermore, carbohydrate metabolism disorders impair uterine scar formation by increasing inflammation, impairing adipocyte migration from the myometrium, and forming a coarse connective tissue scar. This is due not only to inflammatory changes but also to metabolic disturbances at the cellular level, as well as vascular disorders due to endothelial dysfunction. Gestational diabetes is not a direct contraindication to vaginal delivery in patients with a uterine scar, although the risk of uterine rupture in this category of patients is higher than in women without carbohydrate metabolism disorders. It is necessary to carefully consider the range of contraindications to labor induction, particularly macrosomia and obesity, as well as the risk of uterine dysfunction, which collectively worsen the prognosis for vaginal delivery. In the postpartum period, personalized prevention of inflammatory diseases and the formation of an inadequate uterine scar is essential.Conclusion. A review of the literature revealed that most authors consider carbohydrate metabolism disorders as a risk factor for uterine scar insufficiency/incompetence. However, further research is needed to ensure safe delivery for both mother and fetus in patients with a uterine scar after a previous abdominal delivery and gestational diabetes.

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