Преимущества и ограничения грудного вскармливания у матерей со злокачественными новообразованиями

Преимущества и ограничения грудного вскармливания у матерей со злокачественными новообразованиями

Ладодо О.Б., Юрова М.В., Хохлова С.В., Родионов В.В., Шешко Е.Л., Зубков В.В., Макиева М.И., Чуткова Д.А., Ахапкина Е.С., Дегтярев Д.Н. Преимущества и ограничения грудного вскармливания у матерей со злокачественными новообразованиями. Современная Онкология. 2024;26(1):73–79.
DOI: 10.26442/18151434.2024.1.202571

© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.

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Ladodo OB, Iurova MV, Khokhlova SV, Rodionov VV, Sheshko EL, Zubkov VV, Makieva MI, Chutkova DA, Akhapkina ES, Degtyarev DN. Benefits and limitations of breastfeeding for mothers with malignant tumors: A review. Journal of Modern Oncology. 2024;26(1):73–79. DOI: 10.26442/18151434.2024.1.202571

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Аннотация

В современном мире грудное вскармливание (ГВ) рассматривается как значимый фактор снижения рисков развития злокачественных новообразований (ЗНО) молочной железы (МЖ), яичников. Однако по-прежнему открытым остается вопрос сохранения лактации или отказа от ГВ при ЗНО. В последние годы наблюдается неуклонный рост числа ЗНО, особенно в развитых странах, при этом более 10% всех ЗНО МЖ диагностируется у женщин моложе 40 лет. В представленной статье освещены аспекты сохранения лактации в разные периоды актуальности ГВ по отношению к срокам манифестации ЗНО, а также приведены данные многоцентрового исследования POSITIVE (Pregnancy Outcome and Safety of Interrupting Therapy for women with endocrine responsIVE breast cancer) возможностей реализации репродуктивной функции и ГВ у женщин, получающих терапию по поводу гормон-рецептор-положительного (HR+) рака МЖ I–III стадии. ГВ у пациенток с ЗНО, выявленным в послеродовый период, зависит от терапии основного заболевания. Больным, подвергшимся хирургическому лечению, ГВ не противопоказано, однако технически не всегда возможно. На фоне химиотерапии ГВ не рекомендовано. При проведении радиотерапии возможно ГВ с использованием здоровой МЖ. В настоящее время отсутствуют какие-либо данные в пользу того, что кормление грудью, в которой диагностировано ЗНО, может иметь какие-либо негативные эффекты. В целом показано, что сохранение и поддержание лактации у женщин с ЗНО в анамнезе безопасно как для матери, так и для ребенка.

Ключевые слова: BRCA, POSITIVE, гипогалактия, грудное вскармливание, лактация, рак молочной железы, рак яичников, онкофертильность

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In the modern world breastfeeding (BF) is considered as a significant factor in reducing the risk of developing malignant tumors of the mammary gland and ovaries. However, the problem of maintenance or refusing BF in malignant neoplasms (malignant neoplasms) still remains open. In recent years, there has been a steady increase in breast cancer (BC), especially in developed countries, with more than 10% of all breast malignancies (BC) diagnosed in women under 40 years of age. The presented article highlights aspects of maintaining lactation in different periods of the relevance of BF in relation to the timing of manifestation of cancer, and also presents data from the multicenter study POSITIVE (Pregnancy Outcome and Safety of Interrupting Therapy for women with endocrine responsIVE breast cancer) on the possibilities of implementing reproductive function and BF in women receiving therapy for hormone-receptor positive (HR+) BC stages I–III. BF with cancer detected in the postpartum period depends on the treatment of the underlying disease. In patients undergoing surgical treatment, BF is not contraindicated, but it is not always technically possible. During chemotherapy, BF is not recommended. When carrying out radiotherapy, it is possible to undergo BF using a healthy mammary gland. There is currently no evidence to suggest that BF woman diagnosed with cancer may have any negative effects. In general, it has been shown that preserving and maintaining lactation in women with a history of cancer is safe for both mother and child.

Keywords: BRCA, POSITIVE, hypogalactia, breastfeeding, lactation, breast cancer, ovarian cancer, oncofertility

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Список литературы

1. Ellington TD, Miller JW, Henley SJ, et al. Trends in breast cancer incidence, by race, ethnicity, and age among women aged ≥20 Years – United States, 1999‑2018. MMWR Morb Mortal Wkly Rep. 2022;71(2):43‑7. DOI:10.15585/mmwr.mm7102a2
2. Di Mattei VE, Perego G, Taranto P, et al. Psychological issues in breast cancer survivors confronted with motherhood: Literature review and a call to action. Front Psychol. 2023;14:1133204. DOI:10.3389/fpsyg.2023.1133204
3. Lambertini M, Di Maio M, Poggio F, et al. Knowledge, attitudes and practice of physicians towards fertility and pregnancy-related issues in young BRCA-mutated breast cancer patients. Reprod Biomed Online. 2019;38(5):835‑44. DOI:10.1016/j.rbmo.2018.11.031
4. Galati F, Magri V, Arias-Cadena PA, et al. Pregnancy-associated breast cancer: A diagnostic and therapeutic challenge. Diagnostics (Basel). 2023;13(4):604. DOI:10.3390/diagnostics13040604
5. Shanmugam S, Balakrishnan S. Association of breast feeding in ovarian malignancy: Is breastfeeding a boon? A single institutional experience. Int J Reprod Contracept Obstet Gynecol. 2023;12(6):1666‑9.
6. Cramer DW. The epidemiology of endometrial and ovarian cancer. Hematol Oncol Clin North Am. 2012;26(1):1‑12. DOI:10.1016/j.hoc.2011.10.009
7. Holman DA. Fertility preservation in gynecologic cancer. Semin Oncol Nurs. 2019;35(2):202‑10. DOI:10.1016/j.soncn.2019.02.007
8. Юпатов Е.Ю., Курманбаев Т.Е., Шмидт А.А., и др. Криоконсервация репродуктивной ткани – возможность сохранения фертильности (обзор литературы). Проблемы репродукции. 2020;26(5):99‑106 [Yupatov EYu, Kurmanbaev TE, Shmidt AA, et al. Cryopreservation of reproductive tissue – the possibility of preserving fertility (a review). Russian Journal of Human Reproduction. 2020;26(5):99‑106 (in Russian)]. DOI:10.17116/repro20202605199
9. Kim J, Turan V, Oktay K. Long-term safety of letrozole and gonadotropin stimulation for fertility preservation in women with breast cancer. J Clin Endocrinol Metab. 2016;101(4):1364‑71. DOI:10.1210/jc.2015‑3878
10. Lakhoo K, Davies J, Chakraborty S, et al. Development of a new reproductive tissue cryopreservation clinical service for children: The Oxford programme. Pediatr Surg Int. 2019;35(11):1271‑8. DOI:10.1007/s00383‑019‑04503‑3
11. Jordan SJ, Cushing-Haugen KL, Wicklund KG, et al. Breast feeding and risk of epithelial ovarian cancer. Cancer Causes Control. 2012;23(6):919‑27. DOI:10.1007/s10552‑012‑9963‑4
12. Babic A, Sasamoto N, Rosner BA, et al. Association between breastfeeding and ovarian cancer risk. JAMA Oncol. 2020;6(6):e200421. DOI:10.1001/jamaoncol.2020.0421
13. Bhurosy T, Niu Z, Heckman CJ. Breastfeeding is possible: A systematic review on the feasibility and challenges of breastfeeding among breast cancer survivors of reproductive age. Ann Surg Oncol. 2021;28(7):3723‑35. DOI:10.1245/s10434‑020‑09094‑1
14. Dagla M, Mrvoljak-Theodoropoulou I, Karagianni D, et al. Women’s mental health as a factor associated with exclusive breastfeeding and breastfeeding duration: Data from a Longitudinal Study in Greece. Children (Basel). 2021;8(2):150. DOI:10.3390/children8020150
15. Johnson HM, Mitchell KB; Academy of Breastfeeding Medicine. ABM Clinical Protocol #34: Breast cancer and breastfeeding. Breastfeed Med. 2020;15(7):429‑34. DOI:10.1089/bfm.2020.29157.hmj
16. Schnitt SJ, Connolly JL, Harris JR, Cohen RB. Radiation-induced changes in the breast. Hum Pathol. 1984;15(6):545‑50. DOI:10.1016/s0046‑8177(84)80008‑8
17. Leal SC, Stuart SR, Carvalho Hde A. Breast irradiation and lactation: A review. Expert Rev Anticancer Ther. 2013;13(2):159‑64. DOI:10.1586/era.12.178
18. Duffy C, Cyr M. Phytoestrogens: Potential benefits and implications for breast cancer survivors. J Womens Health (Larchmt). 2003;12(7):617‑31. DOI:10.1089/154099903322404276
19. Lambertini M, Blondeaux E, Bruzzone M, et al. Pregnancy after breast cancer: a systematic review and meta-analysis. J Clin Oncol. 2021;39(29):3293‑305. DOI:10.1200/JCO.21.00535
20. Partridge A, Pagani O, Niman S, et al. Abstract GS4‑09: Pregnancy Outcome and Safety of Interrupting Therapy for women with endocrine responsIVE breast cancer: Primary Results from the POSITIVE Trial (IBCSG 48‑14/BIG 8‑13). Cancer Research. 2023;83(5 Suppl.): GS4‑09-GS4‑09. DOI:10.1158/1538‑7445.SABCS22-GS4‑09
21. Ogg S, Klosky JL, Chemaitilly W, et al. Breastfeeding practices among childhood cancer survivors. J Cancer Surviv. 2020;14(4):586‑99. DOI:10.1007/s11764‑020‑00882‑y
22. Haliloglu N, Ustuner E, Ozkavukcu E. Breast ultrasound during lactation: Benign and malignant lesions. Breast Care (Basel). 2019;14(1):30‑4. DOI:10.1159/000491781
23. Sabate JM, Clotet M, Torrubia S, et al. Radiologic evaluation of breast disorders related to pregnancy and lactation. Radiographics. 2007;27(Suppl. 1):S101‑24. DOI:10.1148/rg.27si075505
24. di Florio-Alexander RM, Slanetz PJ, Moy L, et al.; Expert Panel on Breast Imaging. ACR Appropriateness Criteria® breast imaging of pregnant and lactating women. J Am Coll Radiol. 2018;15(11S):S263‑75. DOI:10.1016/j.jacr.2018.09.013
25. Chung M, Ruiz-Cordero R, Lee AY, et al. MRI evaluation of the lactating breast. Curr Radiol Rep. 2022;10(5):57‑67. DOI:10.1007/s40134‑022‑00395‑9
26. Lo AC, Ronckers C, Aznar MC, et al. Breast hypoplasia and decreased lactation from radiation therapy in survivors of pediatric malignancy: A PENTEC comprehensive review. Int J Radiat Oncol Biol Phys. 2021:S0360‑3016(21)02725‑5. DOI:10.1016/j.ijrobp.2021.08.032
27. Wheeler G, Grassberger C, Samers J, et al. Central endocrine complications among childhood cancer survivors treated with radiation therapy: A PENTEC comprehensive review. Int J Radiat Oncol Biol Phys. 2023:S0360‑3016(23)00416‑9. DOI:10.1016/j.ijrobp.2023.04.024
28. Radiotherapy. In: Drugs and Lactation Database (LactMed®). Bethesda (MD): National Institute of Child Health and Human Development, 2006. Available at: https://pubmed.ncbi.nlm.nih.gov/30000783/ Accessed: 30.07.2023.
29. Pistilli B, Bellettini G, Giovannetti E, et al. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: How should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013;39(3):207‑11. DOI:10.1016/j.ctrv.2012.10.002
30. Begg EJ, Duffull SB, Hackett LP, Ilett KF. Studying drugs in human milk: Time to unify the approach. J Hum Lact. 2002;18(4):323‑32. DOI:10.1177/089033402237904
31. Shachar SS, Gallagher K, McGuire K, et al. Multidisciplinary management of breast cancer during pregnancy. Oncologist. 2017;22(3):324‑34. DOI:10.1634/theoncologist.2016‑0208
32. Sella T, Sorouri K, Rosenberg Sh, et al. Abstract P5‑08‑06: Breastfeeding in survivors of early breast cancer. Cancer Research. 2023;83: P5‑08.
DOI:10.1158/1538‑7445.SABCS22-P5‑08‑06
33. Linkeviciute A, Notarangelo M, Buonomo B, et al. Breastfeeding after breast cancer: Feasibility, Safety, and ethical perspectives. J Hum Lact. 2020;36(1):40‑3. DOI:10.1177/0890334419887723
34. Vandenbroucke T, Verheecke M, van Gerwen M, et al. Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy. Eur J Cancer. 2020;138:57‑67. DOI:10.1016/j.ejca.2020.07.004
35. Schwarz EB, Hess R, Trussell J. Contraception for cancer survivors. J Gen Intern Med. 2009;24(Suppl. 2):S401‑6. DOI:10.1007/s11606‑009‑1023‑8
36. Юрова М.В., Межевитинова Е.А., Якушевская О.В., и др. Влияние гормональной контрацепции на риск развития рака молочной железы. Современная Онкология. 2023;25(2):199‑207 [Iurova MV, Mezhevitinova EA, Yakushevskaya OV, et al. The effect of hormonal contraception on the risk of breast cancer: A review. Journal of Modern Oncology. 2023;25(2):199‑207 (in Russian)]. DOI:10.26442/18151434.2023.2.202287
37. FSRH Guideline Contraception After Pregnancy. Faculty of Sexual & Reproductive Healthcare, 2020. Available at: https://www.fsrh.org/standards-and-guidance/documents/contraception-after-pregnancy-guideline-janu... Accessed: 30.07.2023.
38. Чернуха Г.Е., Пронина В.А. Низкодозированная внутриматочная контрацепция – инновационный подход к профилактике нежелательной беременности. Медицинский совет. 2022;16(5):40‑5 [Chernukha GE, Pronina VA. Low-dose intrauterine contraception is an innovative approach to the prevention of unwanted pregnancy. Meditsinskiy Sovet. 2022;16(5):40‑5 (in Russian)]. DOI:10.21518/2079‑701X‑2022‑16‑5-40‑45

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1. Ellington TD, Miller JW, Henley SJ, et al. Trends in breast cancer incidence, by race, ethnicity, and age among women aged ≥20 Years – United States, 1999‑2018. MMWR Morb Mortal Wkly Rep. 2022;71(2):43‑7. DOI:10.15585/mmwr.mm7102a2
2. Di Mattei VE, Perego G, Taranto P, et al. Psychological issues in breast cancer survivors confronted with motherhood: Literature review and a call to action. Front Psychol. 2023;14:1133204. DOI:10.3389/fpsyg.2023.1133204
3. Lambertini M, Di Maio M, Poggio F, et al. Knowledge, attitudes and practice of physicians towards fertility and pregnancy-related issues in young BRCA-mutated breast cancer patients. Reprod Biomed Online. 2019;38(5):835‑44. DOI:10.1016/j.rbmo.2018.11.031
4. Galati F, Magri V, Arias-Cadena PA, et al. Pregnancy-associated breast cancer: A diagnostic and therapeutic challenge. Diagnostics (Basel). 2023;13(4):604. DOI:10.3390/diagnostics13040604
5. Shanmugam S, Balakrishnan S. Association of breast feeding in ovarian malignancy: Is breastfeeding a boon? A single institutional experience. Int J Reprod Contracept Obstet Gynecol. 2023;12(6):1666‑9.
6. Cramer DW. The epidemiology of endometrial and ovarian cancer. Hematol Oncol Clin North Am. 2012;26(1):1‑12. DOI:10.1016/j.hoc.2011.10.009
7. Holman DA. Fertility preservation in gynecologic cancer. Semin Oncol Nurs. 2019;35(2):202‑10. DOI:10.1016/j.soncn.2019.02.007
8. Yupatov EYu, Kurmanbaev TE, Shmidt AA, et al. Cryopreservation of reproductive tissue – the possibility of preserving fertility (a review). Russian Journal of Human Reproduction. 2020;26(5):99‑106 (in Russian). DOI:10.17116/repro20202605199
9. Kim J, Turan V, Oktay K. Long-term safety of letrozole and gonadotropin stimulation for fertility preservation in women with breast cancer. J Clin Endocrinol Metab. 2016;101(4):1364‑71. DOI:10.1210/jc.2015‑3878
10. Lakhoo K, Davies J, Chakraborty S, et al. Development of a new reproductive tissue cryopreservation clinical service for children: The Oxford programme. Pediatr Surg Int. 2019;35(11):1271‑8. DOI:10.1007/s00383‑019‑04503‑3
11. Jordan SJ, Cushing-Haugen KL, Wicklund KG, et al. Breast feeding and risk of epithelial ovarian cancer. Cancer Causes Control. 2012;23(6):919‑27. DOI:10.1007/s10552‑012‑9963‑4
12. Babic A, Sasamoto N, Rosner BA, et al. Association between breastfeeding and ovarian cancer risk. JAMA Oncol. 2020;6(6):e200421. DOI:10.1001/jamaoncol.2020.0421
13. Bhurosy T, Niu Z, Heckman CJ. Breastfeeding is possible: A systematic review on the feasibility and challenges of breastfeeding among breast cancer survivors of reproductive age. Ann Surg Oncol. 2021;28(7):3723‑35. DOI:10.1245/s10434‑020‑09094‑1
14. Dagla M, Mrvoljak-Theodoropoulou I, Karagianni D, et al. Women’s mental health as a factor associated with exclusive breastfeeding and breastfeeding duration: Data from a Longitudinal Study in Greece. Children (Basel). 2021;8(2):150. DOI:10.3390/children8020150
15. Johnson HM, Mitchell KB; Academy of Breastfeeding Medicine. ABM Clinical Protocol #34: Breast cancer and breastfeeding. Breastfeed Med. 2020;15(7):429‑34. DOI:10.1089/bfm.2020.29157.hmj
16. Schnitt SJ, Connolly JL, Harris JR, Cohen RB. Radiation-induced changes in the breast. Hum Pathol. 1984;15(6):545‑50. DOI:10.1016/s0046‑8177(84)80008‑8
17. Leal SC, Stuart SR, Carvalho Hde A. Breast irradiation and lactation: A review. Expert Rev Anticancer Ther. 2013;13(2):159‑64. DOI:10.1586/era.12.178
18. Duffy C, Cyr M. Phytoestrogens: Potential benefits and implications for breast cancer survivors. J Womens Health (Larchmt). 2003;12(7):617‑31. DOI:10.1089/154099903322404276
19. Lambertini M, Blondeaux E, Bruzzone M, et al. Pregnancy after breast cancer: a systematic review and meta-analysis. J Clin Oncol. 2021;39(29):3293‑305. DOI:10.1200/JCO.21.00535
20. Partridge A, Pagani O, Niman S, et al. Abstract GS4‑09: Pregnancy Outcome and Safety of Interrupting Therapy for women with endocrine responsIVE breast cancer: Primary Results from the POSITIVE Trial (IBCSG 48‑14/BIG 8‑13). Cancer Research. 2023;83(5 Suppl.): GS4‑09-GS4‑09. DOI:10.1158/1538‑7445.SABCS22-GS4‑09
21. Ogg S, Klosky JL, Chemaitilly W, et al. Breastfeeding practices among childhood cancer survivors. J Cancer Surviv. 2020;14(4):586‑99. DOI:10.1007/s11764‑020‑00882‑y
22. Haliloglu N, Ustuner E, Ozkavukcu E. Breast ultrasound during lactation: Benign and malignant lesions. Breast Care (Basel). 2019;14(1):30‑4. DOI:10.1159/000491781
23. Sabate JM, Clotet M, Torrubia S, et al. Radiologic evaluation of breast disorders related to pregnancy and lactation. Radiographics. 2007;27(Suppl. 1):S101‑24. DOI:10.1148/rg.27si075505
24. di Florio-Alexander RM, Slanetz PJ, Moy L, et al.; Expert Panel on Breast Imaging. ACR Appropriateness Criteria® breast imaging of pregnant and lactating women. J Am Coll Radiol. 2018;15(11S):S263‑75. DOI:10.1016/j.jacr.2018.09.013
25. Chung M, Ruiz-Cordero R, Lee AY, et al. MRI evaluation of the lactating breast. Curr Radiol Rep. 2022;10(5):57‑67. DOI:10.1007/s40134‑022‑00395‑9
26. Lo AC, Ronckers C, Aznar MC, et al. Breast hypoplasia and decreased lactation from radiation therapy in survivors of pediatric malignancy: A PENTEC comprehensive review. Int J Radiat Oncol Biol Phys. 2021:S0360‑3016(21)02725‑5. DOI:10.1016/j.ijrobp.2021.08.032
27. Wheeler G, Grassberger C, Samers J, et al. Central endocrine complications among childhood cancer survivors treated with radiation therapy: A PENTEC comprehensive review. Int J Radiat Oncol Biol Phys. 2023:S0360‑3016(23)00416‑9. DOI:10.1016/j.ijrobp.2023.04.024
28. Radiotherapy. In: Drugs and Lactation Database (LactMed®). Bethesda (MD): National Institute of Child Health and Human Development, 2006. Available at: https://pubmed.ncbi.nlm.nih.gov/30000783/ Accessed: 30.07.2023.
29. Pistilli B, Bellettini G, Giovannetti E, et al. Chemotherapy, targeted agents, antiemetics and growth-factors in human milk: How should we counsel cancer patients about breastfeeding? Cancer Treat Rev. 2013;39(3):207‑11. DOI:10.1016/j.ctrv.2012.10.002
30. Begg EJ, Duffull SB, Hackett LP, Ilett KF. Studying drugs in human milk: Time to unify the approach. J Hum Lact. 2002;18(4):323‑32. DOI:10.1177/089033402237904
31. Shachar SS, Gallagher K, McGuire K, et al. Multidisciplinary management of breast cancer during pregnancy. Oncologist. 2017;22(3):324‑34. DOI:10.1634/theoncologist.2016‑0208
32. Sella T, Sorouri K, Rosenberg Sh, et al. Abstract P5‑08‑06: Breastfeeding in survivors of early breast cancer. Cancer Research. 2023;83: P5‑08.
DOI:10.1158/1538‑7445.SABCS22-P5‑08‑06
33. Linkeviciute A, Notarangelo M, Buonomo B, et al. Breastfeeding after breast cancer: Feasibility, Safety, and ethical perspectives. J Hum Lact. 2020;36(1):40‑3. DOI:10.1177/0890334419887723
34. Vandenbroucke T, Verheecke M, van Gerwen M, et al. Child development at 6 years after maternal cancer diagnosis and treatment during pregnancy. Eur J Cancer. 2020;138:57‑67. DOI:10.1016/j.ejca.2020.07.004
35. Schwarz EB, Hess R, Trussell J. Contraception for cancer survivors. J Gen Intern Med. 2009;24(Suppl. 2):S401‑6. DOI:10.1007/s11606‑009‑1023‑8
36. Iurova MV, Mezhevitinova EA, Yakushevskaya OV, et al. The effect of hormonal contraception on the risk of breast cancer: A review. Journal of Modern Oncology. 2023;25(2):199‑207 (in Russian). DOI:10.26442/18151434.2023.2.202287
37. FSRH Guideline Contraception After Pregnancy. Faculty of Sexual & Reproductive Healthcare, 2020. Available at: https://www.fsrh.org/standards-and-guidance/documents/contraception-after-pregnancy-guideline-janu... Accessed: 30.07.2023.
38. Chernukha GE, Pronina VA. Low-dose intrauterine contraception is an innovative approach to the prevention of unwanted pregnancy. Meditsinskiy Sovet. 2022;16(5):40‑5 (in Russian). DOI:10.21518/2079‑701X‑2022‑16‑5-40‑45

Авторы

О.Б. Ладодо¹, М.В. Юрова^1,2, С.В. Хохлова^1,3, В.В. Родионов¹, Е.Л. Шешко⁴, В.В. Зубков^1,2, М.И. Макиева¹, Д.А. Чуткова*¹, Е.С. Ахапкина¹, Д.Н. Дегтярев^1,2

¹ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Россия;
²ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
³ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
⁴Министерство здравоохранения Российской Федерации, Москва, Россия
*huhreva@gmail.com

________________________________________________

Olga B. Ladodo¹, Mariia V. Iurova^1,2, Svetlana V. Khokhlova^1,3, Valerii V. Rodionov¹, Elena L. Sheshko⁴, Victor V. Zubkov^1,2, Mziya I. Makieva¹, Dar’ia A. Chutkova*¹, Elena S. Akhapkina¹, Dmitriy N. Degtyarev^1,2

¹Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia;
²Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
³Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
⁴Ministry of Health of the Russian Federation, Moscow, Russia
*huhreva@gmail.com

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