Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 16 , ISSUE S1 ( April, 2024 ) > List of Articles

Original Article

Morphological and Histopathological Features of Placenta in Women with Gestational Diabetes Mellitus and Its Association with Perinatal Outcome

M Kavya Venkatesh, Shraddha K Shetty, GV Chaithra

Keywords : Calcification, Gestational diabetes mellitus, Infarction, Placental weight, Placental shape, Villous edema

Citation Information :

DOI: 10.5005/jp-journals-10006-2389

License: CC BY-NC 4.0

Published Online: 06-03-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Placenta, a unique vascular organ, acts as a barrier between maternal and fetal circulation, protecting the fetus from adverse effects of maternal diseases. Gestational diabetes mellitus (GDM) alters the placental function leading to histological and morphological changes in placenta. Hyperglycemia affects placental development leading to adverse maternal and perinatal outcomes. Aim: To understand the morphological and histopathological variations of the placenta in GDM pregnancies and its association with the perinatal outcome. Materials and methods: A hospital-based cross-sectional study was conducted in women with singleton pregnancy between 37 and 40 weeks of gestation with GDM (Cases) and compared with women without GDM (Control). The morphological and histopathological features of the placenta were studied, and the associated perinatal outcome was analyzed. Results: In cases, most of the women had babies with birth weight of 3.51–4 kg (57.1%) and was statistically significant (p = 0.001). The mean placental weight among cases and controls was 719.57 ± 110. 8 gm and 380.71 ± 50.59 gm, respectively. Placental histopathological changes (calcification of the placenta, fibrinoid necrosis of villi and immature villous) were noted in cases and were statistically significant (p = 0.001). Abnormal perinatal outcomes were observed in cases with an oval-shaped placenta (64.7%), increased cord thickness (68.4%), fibrinoid necrosis of villi (50%), syncytial knots (61.9%), and immature villous (54.5%). Conclusion: Gestational diabetes mellitus causes an alteration in morphological and histological features of the placenta resulting in adverse perinatal outcomes. Early diagnosis, treatment, and glycemic control aid in reducing perinatal morbidity and mortality.


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  1. Kishwara S, Ara S, Rayhan K, et al. Morphological changes of placenta in preeclampsia. Bangladesh J Anat 2009;7(1):49–54. DOI: 10.3329/BJA.V7I1.3026.
  2. Forsbach-Sánchez G, Tamez-Peréz HE, Vazquez-Lara J. Diabetes and pregnancy. Arch Med Res 2005;36(3):291–299. DOI: 10.1016/j.arcmed.2005.03.001.
  3. Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes. Diabet Med 2004;21(2):103–113. DOI: 10.1046/j.1464-5491.2003.00985.x.
  4. Radaelli T, Lepercq J, Varastehpour A, et al. Differential regulation of genes for fetoplacental lipid pathways in pregnancy with gestational and type 1 diabetes mellitus. Am J Obstet Gynecol 2009;201(2):209. DOI: 10.1016/j.ajog.2009.04.019.
  5. Segregur J, Buković D, Milinović D, et al. Fetal macrosomia in pregnant women with gestational diabetes. Coll Antropol 2009;33(4): 1121–1127. PMID: 20102057.
  6. Lao TT, Lee CP, Wong WM. Placental weight to birthweight ratio is increased in mild gestational glucose intolerance. Placenta 1997;18(2–3):227–230. DOI: 10.1016/s0143-4004(97)90097-7.
  7. Taricco E, Radaelli T, Nobile de Santis MS, et al. Foetal and placental weights in relation to maternal characteristics in gestational diabetes. Placenta 2003;24(4):343–347. DOI: 10.1053/plac.2002.0913.
  8. Sanin L, López S, Olivares E, et al. Relation between birth weight and placenta weight. Neonatology 2001;80(2):113–117. DOI: https://doi.org/10.1159/000047129.
  9. Gauster M, Desoye G, Tötsch M, et al. The placenta and gestational diabetes mellitus. Curr Diab Rep 2012;12(1):16–23. DOI: 10.1007/s11892-011-0244-5.
  10. Kühl C, Hornnes PJ, Andersen O. Etiology and pathophysiology of gestational diabetes mellitus. Diabetes 1985;34(Suppl. 2):66–70. DOI: 10.2337/diab.34.2.s66.
  11. Kallem VR, Pandita A, Pillai A. Infant of diabetic mother: What one needs to know? J Matern Fetal Neonatal Med 2020;33(3):482–492. DOI: 10.1080/14767058.2018.1494710.
  12. Mitanchez D, Yzydorczyk C, Simeoni U. What neonatal complications should the pediatrician be aware of in case of maternal gestational diabetes? World J Diabetes 2015;6(5):734–743. DOI: 10.4239/wjd.v6.i5.734.
  13. Nafees H, Jain S, Khare S, et al. Histopathological study of placental villi in pre-eclampsia-a quantitative study. J Anat Soc India 2012;61(2):159–162. DOI: 10.1016/S0003-2778(12)80024-4.
  14. ACOG technical bulletin. Diabetes and pregnancy. Number 200–December 1994 (replaces No. 92, May 1986). Committee on Technical Bulletins of the American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 1995;48(3):331–339. PMID: 7781883.
  15. Calderon IM, Damasceno DC, Amorin RL, et al. Morphometric study of placental villi and vessels in women with mild hyperglycemia or gestational or overt diabetes. Diabetes Res Clin Prac 2007;78(1):65–71. DOI: 10.1016/j.diabres.2007.01.023.
  16. Saddler TW. Placenta and fetal membranes. In Langman's medical embryology. NY USA: Lippincott Williams & Wilkins, 2004. pp. 91–111.
  17. Bhanu SP, Sankar DK, Swetha M, et al. Gross morphological study of gestational diabetes mellitus placenta from south Indian mothers compared with control placenta. Int J Anat Res 2017;5(1):3521–3526. DOI: 10.16965/ijar.2017.102.
  18. Sheela VP, Padmaja R, Vijayalakshmi. Maternal and perinatal outcomes in GDM: A study. J Evid Based Med Healthc 2015;2(11):1593–1594. DOI: 10.18410/jebmh/227.
  19. Hiden U, Glitzner E, Hartmann M, et al. Insulin and the IGF system in the human placenta of normal and diabetic pregnancies. J Anat 2009;215(1):60–68. DOI: 10.1111/j.1469-7580.2008.01035.x.
  20. Yang HX. Placental pathology in gestational diabetes. Placenta 1993;28(12):758–759. PMID: 8137639.
  21. Hertig AT. Pathological aspects in: Villee CA Placenta and Fetal Membranes. NY, USA: Williams & Wilkins, 1960. pp. 109–124.
  22. Woodling BA, Kroener JM, Puffer HW, et al. Gross examination of the placenta. Clin Obstet Gynecol 1976;19(1):21–44. DOI: 10.1097/00003081-197603000-00004.
  23. Teasdale F. Histomorphometry of the placenta of the diabetic women: Class A diabetes mellitus. Placenta 1981;2(3):241–251. DOI: 10.1016/s0143-4004(81)80007-0.
  24. Boyd PA, Scott A, Keeling JW. Quantitative structural studies on placentas from pregnancies complicated by diabetes mellitus. Br J Obstet Gynaecol 1986;93(1):31–35. DOI: 10.1111/j.1471-0528.1986.tb07809.x.
  25. Chowdhury A, Shamim K, Ferdousi R, et al. A Comparative Study of Effects of Different Grades of Maternal Established Diabetes Mellitus on Placental and Neonatal Weight. Bangladesh J Anat 2011;9(1): 53–58. DOI: https://doi.org/10.3329/bja.v9i1.8150.
  26. Driscoll SG. The pathology of pregnancy complicated by diabetes mellitus. Med Clin N Am 1965;49(4):1053–1067. DOI: https://doi.org/10.1016/S0025-7125(16)33295-3.
  27. Hayward CE, Lean S, Sibley CP, et al. Placental adaptation: What can we learn from birthweight: placental weight ratio? Front Physiol 2016;7:28. DOI: 10.3389/fphys.2016.00028.
  28. Ahmed TME. Effect of gestational diabetes on gross morphology, histology and histochemistry of human placenta. Endocrinol Metab Syndr 2016;5(1):227. DOI: 10.4172/2161-1017.1000227.
  29. Pathak S, Hook E, Hackett E, et al. Cord coiling, umbilical cord insertion and placental shape in an unselected cohort delivering at term: Relationship with common obstetric outcomes. Placenta 2010;31:963–968. DOI: 10.1016/j.placenta.2010.08.004.
  30. Saha S, Biswas S, Mitra D, et al. Histologic and morphometric study of human placenta in gestational diabetes mellitus. Ital J Anat Embryol 2014;119(1):1–9. PMID: 25345070.
  31. Memon S, Goswami P, Lata H. Gross and histological alteration in the placenta of mothers suffering from gestational diabetes. J Liaquat Uni Med Health Sci 2015;14(1):16–20. Corpus ID: 71039481.
  32. Madazli R, Tuten A, Calay Z, et al. The incidence of placental abnormalities, maternal and cord plasma malondialdehyde and vascular endothelial growth factor levels in women with gestational diabetes mellitus and nondiabetic controls. Gynecol Obstet Invest 2008;65(4):227–232. DOI: 10.1159/000113045.
  33. Verma R, Mishra S, Kaul JM. Cellular changes in the placenta in pregnancies complicated with diabetes. Int J Morphol 2010;28(1): 259–264. DOI: 10.4067/S0717-95022010000100038.
  34. Amal T, Elghait A, Hoda A, et al. Histological and immunohistochemical changes in placental chorionic villi of patients with poorly controlled gestational diabetes. Egypt J Histol 2012;35(2):259–271. DOI: 10.1097/01.EHX.0000414585.81633.b3.
  35. Gheorman L, Pleşea IE, Gheorman V. Histopathological considerations of placenta in pregnancy with diabetes. Rom J Morphol Embryol 2012;53(2):329–336. PMID: 22732802.
  36. Potter C. Infant of diabetic mother. E medicine specialties, neonatology [serial online] 2006; Available on: http://www.emedicine.com. Accessed June 2008.
  37. Khaskhelli LB, Memon S, Goswami P, et al. Change in normal morphology of placenta and its possible effects on fetal outcome in diabetic mothers as compared to non-diabetic mothers. JLUMHS 2013;12(1):49–54. Corpus ID: 42425634.
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