ISSN 2415-3060 (print), ISSN 2522-4972 (online)
  • 31 of 50
JMBS 2021, 6(1): 213–221
Social medicine and organization of health care

Medical and Social Justification of the Implementation of the Optimized Model of Prevention of Genetically Determined Reproductive Losses

Alieva T. D. K. 1,2

Among the objects of organizational influence of the health care system on reproductive losses, miscarriages and congenital malformations (birth defects) are the most important. Diagnosis of most genetic, chromosomal diseases and malformations of the embryo and fetus is performed using biochemical, cytogenetic, molecular genetic tests and ultrasound diagnostic. Many clinical geneticists focus on birth defects and miscarriages associated with folate cycle disorders related with the greatest number of reproductive losses. We studied levels of homocysteine, folic acid and vitamin B12 in pregnant blood and polymorphic genes C677T MTHFR and A66G MTRR considered due to folate cycle disorders. The purpose of the study was to analyze the organizational aspects of the existing model for the prevention of genetically determined reproductive losses and to propose measures to improve the model. Material and methods. The methods of system approach and analysis, bibliosemantic, prospective, economic, expert assessments provided by the specialty passport (14.02.2003) "Social Medicine" were used for the research. Research period: 2008–2018. Place of research: "Interregional Specialized Medical and Genetic Center – Center for Rare (Orphan) Diseases" of Kharkiv Regional Council. Genetic maps of the archive and own patients, normative-legal acts, data of medical statistics were analyzed. Results and discussion. The study suggested an optimized model for the prevention of genetically determined reproductive losses, which took into account examinations for homocysteine, folic acid, vitamin B12 levels, MTHFR and MTRR genes to find their polymorphism, ultrasound, prevention using diet and vitamin therapy, involving gynecologists, family physicians and clinical geneticists. The principles of accessibility, safety, effectiveness, timeliness, cost-effectiveness, protection of rights and freedoms (non-discrimination), personal orientation, legal basis, cooperation with other medical and non-medical organizations and institutions, prevention character, complexity and variety of forms of physician’s cooperation who provide care to pregnant with reproductive losses in anamnesis, couples planning a pregnancy, newborns with birth defects, chromosomal, genetic diseases and syndromes. The efficient and uninterrupted operation of the developed optimized system is ensured with the participation of "feedback" mechanisms. Adherence to the proposed model will provide an opportunity to significantly reduce reproductive losses in the coming years in Ukraine, provided that its principles are included in the relevant national programs and protocols

Keywords: genetically determined reproductive losses, model of prevention, medical and social substantiation, guaranteed medical services, polymorphism of folate cycle genes

Full text: PDF (Ukr) 467K

  1. Tan TC, Ku CW, Kwek LK, Lee KW, Zhang X, Allen Jr JC, et al. Novel approach using serum progesterone as a triage to guide management of patients with threatened miscarriage: a prospective cohort study. Sci Rep. 2020; 9153(10): 1-7. PMid:32499581 PMCid:PMC7272626
  2. Ruhlyada NN, Reznik VA, Libovat A, Prohorovich TI, Pahalage Chanilka P, Yakovlev AA. Akusherskie aspekty vykidysha [Obstetric aspects of miscarriage]. Global Reproduction. 2020; 1: 20-2. [Russian]
  3. Pourakbar R, Ahmadi H, Yousef M, Aghebati-Maleki L. Cell therapy in female infertility-related diseases: Emphasis on recurrent miscarriage and repeated implantation failure. Life Sci. 2020; 258: 118181. PMid:32763291
  4. Mekonnen AG, Hordofa AG, Kitila TT, Sav А. Modifiable risk factors of congenital malformations in bale zone hospitals, Southeast Ethiopia: an unmatched case-control study. BMC Pregnancy Childbirth. 2020; 129(20): 1-9. PMid:32106830 PMCid:PMC7045613
  5. Fisher SC, Howley MM, Van Zutphen AR, Reefhuis J, Browne ML. Maternal surgery and anesthesia during pregnancy and risk of birth defects in the National Birth Defects Prevention Study, 1997-2011. Birth Defects Res, 2020;112(2):162-74. PMid:31840947 PMCid:PMC7667990
  6. World Health Organization. Poroki razvitiya [Malformations]. 2016 Sep 7. [Internet]. [Russian]. Available from:
  7. Mistsevyi protokol Kharkivskoho mizhrehionalnoho spetsializovanoho medyko-henetychnoho tsentru - Genter of Rare (syritskykh) zakhvoryuvan «Prekontseptsiya (pervynna) profilaktyka henetychnykh defektiv» [Local protocol of the Kharkiv Interregional Specialized Medical-Genetic Center - the Genter of Rare (Orphan) Diseases "Preconception (primary) prevention of genetic defects"]. 2020 June; 1-23. [Ukrainian]
  8. United Nations Millennium Declaration. Resolution 55/2 adopted by the UN General Assembly on 8 September 2000. [Internet]. Available from:
  9. Universal Declaration of Human Rights. Proclaimed by the UN General Assembly Resolution 217 A (III) in Paris on 10 December 1948 [Internet]. Available from:
  10. Konstytutsiya Ukrainy [Constitution of Ukraine] Document No. 254k/96-BP. Information of the Verkhovna Rada of Ukraine (VVR) [Internet]. 1996; 30: 141. [Ukrainian]. Available from:к/96-вр
  11. Simeynyi kodeks Ukrainy [Family Code of Ukraine]. Information of the Verkhovna Rada of Ukraine (VVR). [Internet]. 2002; 21-22: 135. [Ukrainian]. Available from:
  12. Tsyvilnyi kodeks Ukrainy [The Civil Code of Ukraine]. Information of the Verkhovna Rada of Ukraine (VVR). [Internet]. [Ukrainian]. 2003; 40-44: 356. Available from:
  13. Criminalnyi kodeks Ukrainy [Criminal codex of Ukraine]. Information of the Verkhovna Rada of Ukraine (VVR). [Internet]. 2001; 25-26: 131. [Ukrainian]. Available from:
  14. Zakon Ukrainy "Pro okhoronu dytynstva" [Law of Ukraine "On Childhood Protection"]. No. 2402-III of 2001 Apr 26. Information of the Verkhovna Rada of Ukraine (VVR). [Internet]. 2001; 30: 142. [Ukrainian]. Available from:
  15. Guse K, Levine D, Martins S, Lira A, Gaarde J, Westmorland W, Gilliam M. Interventions using new digital media to improve adolescent sexual health: a systematic review. J Adolesc Health. 2012 Dec; 51(6): 535-43. PMID: 23174462. PMid:23174462
  16. Voronenko YuV, Moiseenko RO, Knyazevich VM, Martyniuk VYu, Tereshchenko AV, Nazar OV. Orhanizatsiya paliatyvnoi dopomohy dityam v Ukraini - vymoha chasu [Organization of palliative care for children in Ukraine - a requirement of time]. Modern pediatrics. 2016; 3: 10-4. [Ukrainian]
  17. Ognev VA, Chukhno IA. Sotsialne blahopoluchchya v konteksti zabezpechennya sotsialnoho rozvytku derzhavy ta okhorony zdorov'ya [Social well-being in the context of ensuring the social development of the state and public health]. Proceedings of the First International Ukrainian-German Symposium on Public Health "Public Health in the Social and Educational Space - Challenges of the Present and Prospects for Development". Ternopil; 2019 Sep 25-26. Ternopil: TNMU; 2019. p. 11-14. [Ukrainian]
  18. Lekhan VM, Slabkyy GO. Stratehiya rozvytku okhorony zdorov'ya: ukrainskyi vymir [Healthcare Development Strategy: The Ukrainian Dimension]. Medicine and Pharmacy News. 2011; 383: 6-18. [Ukrainian]
  19. Hruzyeva TS, Grechyshkina NV, Lytvynova LO. Hromadske zdorov'ya yak nova spetsialnist: Suchasni pidkhody do navchannya (na prykladi Universytetu Debretsen, Uhorshchyna) [Public Health as a new specialty: Modern approaches to teaching (on the example of the University of Debrecen, Hungary)]. Ukraine. The Health of Nation. 2017; 1(42): 166-72. [Ukrainian]
  20. Klymenko VI, Kremsarʹ IM. Materialno-tekhnichnyi stan tsentriv pervynnoi medyko-sanitarnoi dopomohy Zaporizkoi oblasti dlya zabezpechennya profilaktyky zakhvoryuvan systemy krovoobihu [Material and technical condition of primary health care centers of Zaporizhia region to ensure prevention of diseases of the circulatory system[. Abstracts of the All-Ukrainian Scientific-Practical Conference (to the 50th Anniversary of the ZSMU) "Topical issues of modern medicine and pharmacy". Zaporizhia; 2018 Apr 18-25, May 30. Zaporizhia: ZSMU; 2018. p. 14. [Ukrainian]
  21. Lashkul ZV, Bobkova OV. Scientific substantiation of optimization of the model of "Youth-friendly clinics" for the prevention of adolescent morbidity associated with behavioral risk factors. Intermedicaljournal (Slovakia). 2017; 1(9): 23-37.
  22. Detsyk OZ, Bratsyun OP. Vyvchennya potreb patsiyentiv u protsesi paliatyvnoi dopomohy na ambulatornykh zasadakh [Study of patients' needs in the process of palliative care at the outpatient basis]. Bulletin of Social Hygiene and Health Protection Organization of Ukraine. 2020; 1: 42-7. [Ukrainian].
  23. Pariy VD, Korotkyy OV. Pariy VD, Short OV. Formuvannya ta rozvytok pervynnoi medyko-sanitarnoi dopomohy na zasadakh zahalnoi praktyky simeynoi medytsyny v Ukraini: ohlyad literaturnykh dzherel [Formation and development of primary health care on the basis of general practice-family medicine in Ukraine: a review of literature sources]. Ukraine. The health of the nation. 2018; 2(49):48-53. [Ukrainian]
  24. Pasport spetsialnosti 14.02.03 - Sotsialna medytsyna, zatverdzhenyi Postanovoyu Prezydiyi VAK Ukrainy №18-09 / 4 vid 2003 roku 09 kvitnya (chynnyi) [Passport of specialty 14.02.03 - Social Medicine, approved by the Resolution of the Presidium of the Higher Attestation Commission of Ukraine №18-09/4 from 2003 Apr 09 (valid)]. Bulletin of the Higher Attestation Commission of Ukraine. 2004; 1: 1-9. [Ukrainian]
  25. Prohrama medychnykh harantiy: Vprovadzhennya v Ukraini. Ministerstvo okhorony zdorov'ya Ukrainy, transformatsiyi systemy okhorony zdorov'ya [Medical guarantees program: Implementation in Ukraine. Ministry of Health Care of Ukraine, transformations of the health care system]. 12 p. [Ukrainian]. Available from:
  26. Zakon Ukrainy "Pro derzhavni finansovi harantiyi medychnoi dopomohy" No 2168-VIII vid 2017 roku 19 zhovtnya (chynnyi) [Law of Ukraine "On state financial guarantees of medical care" No. 2168-VIII from 2017 Oct 19 (valid)]. Information of the Verkhovna Rada of Ukraine (VVR). [Internet]. 2018; 5: 31. [Ukrainian]. Available from:
  27. Ukrainskyi kontekst realizatsiyi prohramy medychnykh harantiy [Ukrainian context of implementation of the program of medical guarantees]. In: Analytical Reference of the Ministry of Health of Ukraine "The program of medical guarantees: implementation in Ukraine". [Internet]. 2017: 1-12. [Ukrainian]. Available from:
  28. Zakon Ukrainy No 2801-XII vid 1992 r. 19 lystopada "Osnovy ukrainskoho zakonodavstva pro okhoronu zdorov'ya" (chynnyi) [Law of Ukraine No. 2801-XII from 1992 Nov 19 "Fundamentals of Ukrainian legislation on health care" (valid)]. Information of the Verkhovna Rada of Ukraine (VVR). [Internet]. 1993; 4: 19. [Ukrainian]. Available from:
  29. Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a Systematic review and meta-analysis. Am J Obstet Gynecol. 2017; 217(1): 27-36. PMID: 28268196. PMid:28268196
  30. Baranov VS, Aylamazyan EK. Prikladnye i fundamentalnye napravleniya prenatalnoi diahnostiki [Applied and fundamental directions of prenatal diagnostics]. Journal of Obstetrics and Women's Diseases. 2012; 61(3): 54-60. [Russian]
  31. Klimkina II. Tsitohenetichna otsinka mutahennoi nebezpeki urbanizovanikh teritoriy Ukraini [Cytogenetic estimation of mutagenic danger of the urbanized territories of Ukraine]. Abstr. PhDr. (Biol.). K; 2003. 20 p. [Ukrainian]
  32. Kirihara N, Kamitomo M, Tabira T, Hashimoto T, Taniguchi H, Maeda T. Effect of probiotics on perinatal outcome in patients at high risk of preterm birth. J Obstet Gynaecol Res. 2018 Feb; 44(2): 241-7. PMID: 28994162. PMid:28994162
  33. Grechanina EYa, Grechanina YuB, Alieva TD. Inf Lyst pro innovatsiyi v systemi okhorony zdorov'ya (№ 162-2017, № 1, Medychna henetyka) "Sposib profilaktyky reproduktyvnykh vtrat pry hiperhomotsysteyinemiyi" [Inf Letter on Innovations in Health Care System (No.162-2017, is. 1, Medical Genetics) "Method of prevention of reproductive losses in hyperhomocysteinemia"]. K: Ukrmedpatentinform; 2017. p. 1-3. [Ukrainian]
  34. Patent 53270 Ukraine, MPK G01N 33/48 (2006.01). Sposib profilaktyky reproduktyvnykh vtrat pry hiperhomotsysteyinemiyi [Method for prophylactics of reproductive losses at hyperhomocysteinemia] / Grechanina OYa, Grechanina YuB, Gusar VV, Vasilieva OV, Alieva TD. (UA); zayavnik i vlasnik patentu Kharkiv National Medical University (UA). № u201005921; zayavl 17.05.10 ; opubl 27.09.10. Byul № 18. [Ukrainian]
  35. Cordero AM, Crider KS, Rogers LM, Cannon MJ, Berry RJ. Optimal Serum and Red Blood Cell Folate Concentrations in Women of Reproductive Age for Prevention of Neural Tube Defects: World Health Organization Guidelines. Morbidity and Mortality Weekly Report (MMWR). 2015 Apr 24 (weekly); 64(15): 421-423.
  36. Andrianova MYu, Roytman YeV, Isaeva AM, Kolesnikova IM, Nureyev MV. Patohenetycheskoe y klynycheskoe obosnovanye kompleksnoy profylaktyky hyperhomotsysteynemyi [Pathogenetic and clinical substantiation of complex prevention of hyperhomocysteinemia]. Arch Int Med. 2014; 18(4): 32-8. [Russian]
  37. Nakaz MOZ Ukrainy No 504 vid 2018 r. 19 bereznya "Pro zatverdzhennya Poryadku nadannya pervynnoi medychnoi dopomohy" [Order of the Ministry of Health Care of Ukraine No. 504 from 2018 Mar 19 "About the statement of the Order of rendering of primary medical care"]. Information of the Verkhovna Rada of Ukraine (VVR). [Internet]. [Ukrainian]. Available from:
  38. Nakaz Ministerstva okhorony zdorov'ya Ukrainy №1881 vid 2018 roku vid 19 zhovtnya "Pro zatverdzhennya Sfery nadannya vtorynnoi (spetsializovanoi) medychnoi dopomohy, yaka povynna nadavatysya multydystsyplinarnymy likarnyamy intensyvnoi terapiyi pershoho ta druhoho rivniv, ta Zminy do Poryadku rehionalizatsiyi perynatalnoi dopomohy" [Order of the Ministry of Health Care of Ukraine No. 1881 from 2018 Oct 19 "About the statement of Scope of rendering of secondary (specialized) medical care which should be provided by multidisciplinary intensive care hospitals of the first and second levels, and Changes to the Order of regionalization of perinatal care"]. Information of the Verkhovna Rada of Ukraine (VVR). [Internet]. [Ukrainian]. Available from:
  39. Nakaz Ministerstva okhorony zdorov'ya Ukrainy No 586 vid 2020 r. 28 lyutoho "Pro zatverdzhennya Poryadku napravlennya patsiyentiv do zakladiv okhorony zdorov'ya ta fizychnykh osib - pidpryyemtsiv, yaki u vstanovlenomu zakonom poryadku otrymaly litsenziyu na zdiysnennya hospodarskoi diyalnosti z medychnoi praktyky ta nadannya medychnoi dopomohy vidpovidnoho typu" [Order of the Ministry of Health Care of Ukraine No. 586 from 2020 Feb 28 "About the statement of the Order of referral of patients to health care institutions and physical persons - businessmen who in the order established by the law received the license for carrying out economic activity on medical practice and render medical care of the corresponding type"]. Information of the Verkhovna Rada of Ukraine (VVR). [Internet]. [Ukrainian]. Available from: