Placental Morphology And Feto-Maternal Outcomes In Gestational Diabetes

Authors

  • Rabia Arshad
  • Nasim Karim
  • Fahad Azam

Keywords:

Gestational Diabetes Mellitus, Placenta, Placental morphology, Fetal outcome, Maternal outcome

Abstract

Objective: To observe the placental morphology and feto- maternal outcomes in patients having gestational diabetes mellitus. Materials and Methods: In this descriptive pilot study placentae were collected from 20 patients having gestational diabetes. They received oral and or parenteral drugs along with diet control and exercise during pregnancy. After verbal informed patients, placentae were collected within 30-40 minutes of delivery and preserved in formalin. Gross examination was done including weight, size consistency of placental tissue, attachment, size and color of the cord, membranes complete or incomplete, retro-placental hemorrhages and any other gross abnormality in the placental tissue. Weight and health of the baby and mode of delivery were observed as determinants of fetal and maternal outcome.

Results: Mean placental size was 18.3±3.22 cm and 14.2±2.14 cm in two dimensions with mean placental width of 2.4±0.94 cm. Mean placental weight was 680± 122.9 grams, mean cord length was 19.55±7.22 cm and mean cord width 1.17±0.51cm. Out of 20 placentae, 13 placentae were disc shaped, 19 placentae were soft in consistency, 8 were blue in color, 7 had central insertion of umbilical cord, 14 had complete membranes and 16 had other gross pathologies such as hemorrhages, fibrinoid necrosis etc. Weight of the baby was 3.4±0.38 kg. There was 1 intrauterine death and out of 20 patients 13 had cesarean deliveries.

Conclusion: Gross morphology of placenta exhibited deformities with adverse fetal and maternal outcomes in patients with gestational diabetes mellitus

Key words: Gestational Diabetes Mellitus, Placenta, Placental morphology, Fetal outcome, Maternal outcome

References

Territi K, Ekbald U, Vehlberg T, Ronnemaa T. Comparison of metformin and insulin in the treatment of gestational diabetes :A retrospective ;Case Control Study.Rev Diabet Stud 2008 ;5(2):95-101.

Serlin DC, Lash RW. Diagnosis and management of gestational diabetes. Am Fam Physician 2009 ;80(1):57-62.

Catalano PM, Kirvan JP, Mouzon SH,King J. Gestational diabetes and insulin resistance: Role in long and short term complications for mother and fetus. J Nutr 2003;133:1638 -78.

Hassan JA, Karim N, Sheikh Z. Metformin prevents macrosomia and neonatal morbidity in Gestational Diabetes.Pak J Med Sci 2012; 28(3):384-89.

Anna V, Von Der Ploeg HP, Cheung NW, Hulxley R, Bauman AE. Socio-demographic correlates of the increasing trends in prevalence of Gestational Diabetes Mellitus in a large population of women between 1995 and 2005. Diabetic Care 2008;31: 2288-93.

Alonso A, DelRey CG, Navarro A, Tolivia J, Gonzalez CG .Effects of gestational diabetes mellitus on proteins implicated in insulin signaling in human placenta. Gynecol Endocrinol 2006 ;22(9):526-35.

Bernirchke K .The Placenta: How to examine it and what you can learn. ContempObst and Gynecol 1981;17:117-19.

Leach L, Taylor A, Sciota F. Vascular dysfunction in the diabetic placenta: cause and consequences. J Anat 2009 ;215:69-76

Fowden.A.L, Forhead A.J, Coan P.M, Burton G.J. The Placenta and Intrauterine Programming. Journal of Neuroendocrinology 2008; 20: 439-50.

Nelson SM, Coan MP, Burton GJ, Lindsay RS. Placental structure in type 1 diabetes: relations to fetal insulin; leptin and IGF 1. Diabetes 2009; 58(11) : 2634-41

CowetRM. The infant of diabetic mother. Neo Review 2002; 3(9): 173-89

Madazal R ,Tuten A, Calary Z ,Uzun H ,Uludag S,Ocak V.Incidence of Placental Abnormalities, Maternal and Cord Plasma Malondialdehyde and Vascular Endothelial Growth FactorsLevels in Women with Gestational Diabetes Mellitus and Nondiabetic controls.GynecolObstet Invest 2008;65(4):227-32

Cambell IW ,Duncan C , Urquhart R , Evans M. Placental dysfunction and still birth in gestational diabetes mellitus.British J Diabetes and Vascular Diseases 2009 ;9(1):38-40

Debella D, Snell-Bergeon JK, Hartsfield CL,Bischoff JK, Hamman RF, McDuffie RS. Increasing prevalence of gestational diabetes mellitus over time andby birth cohort. Diabetes Care 2005;28 :579- 84.

Kucuk M, Doymaz F. Placental weight and placental weight ratio are increased in diet and exercise treatment in GDM subjects but not in subjects with abnormal value on 100 gm oral glucose tolerance test. Journal of diabetes and its complications 2009;23(1):25-31.

Taricco E, Radaelli T, Nobile de Santis MS, Cetin I: Fetal and placental weight in relation to maternal characteristics in gestational diabetes. Histological placental lesions in women with recurrent preterm delivery .Placenta 2003, 24:343- 47

Chau YS, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ et al.Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 2007; 30(3):2070-76.

Ashfaq M, Janjua Z M, Channa M A. Effect of gestational diabetes and maternal hypertension on gross morphology of placenta.J Ayub Med CollAbottabad 2005;17(1):44-7.

Akhter .F, AnjumanBanu. M ,Ferdaus R.Effect of Gestational Diabetes Mellitus on Gross Morphological Structure of Preterm placenta. Bangladesh Journal of Anatomy 2010; 8(1): 34-38

Yalter FJ. Placental size and shape with the examination of placenta. Am Fam Physician 1998; 579(5): 1045-54

Predanic M. Sonographic assessment of umbilicalcords. Donald School journal of ultrasound in obstetrics and gynecology 2009 ; 3(2): 48-57

Verma R, Mishra S, Kaul JM.Cellular changes in the placenta in pregnancies complicated with diabetes. Int J Morphol 2010; 28(1):259-64

Katzman PJ, Genest DM. Maternal floor infarction and massive fibrin deposition: Histological definition, association with intrauterine fetal growth restriction and risk of recurrence. Pediatric Developmental Pathol 2002; 5(2):159-64

Bane AL, Gillan JE. Massive perivillousfibrinoid causing recurrent placental failure. BJOG 2003;110 :292-5

Tewari V, Tewari A, Bhardwaj N. Histological and histochemical changes in placenta of diabetic pregnant females and its comparision with normal placenta.Asian Pacific J Tropical Dis2011;1:1-4.

Boyd PA, Scott AK ,Keeling J W. Quantitative structural studies, on placentas from pregnancies complicated by diabetes mellitus . Br J ObstetGynaecol1986;93:31-5

Salomaon LJ, Bernard JP, Ville Y. Estimated fetal weight: reference rang at 20-36 weeks gestation and comparison with actual birth weight reference range. Ultrasound ObstetGynecol 2007; 29: 550-5

Odar E, Wandabwa J, Kiondo P. Maternal and fetal outcome of gestational diabetes mellitus in Mulago Hospital, Uganda. Afr Health Sci. 2004; 4(1): 9-14

Janson T, Certin I, Powell TL, Desoye G, Radaelli T, Ericsson A et al. Placental transport and metabolism in fetal overgrowth, A workshop report. Placenta 2006; 27(A): 109-13

Goldman M, Kitzmiller I, Abrams B, Cowan R, Laros, R jr. Obstetric Complications With GDM: Effects of Maternal Weight. Diabetes 1991; 40(2): 279-82. doi: 10.2337/diab.40.2.

Farooq MU, Ayaz A, Ali Bahool A, Ahmed I. Maternal and neonatal outcomes in gestational diabetes mellitus. Int J EndocrinolMetab 2007; 3:109-15

Günter HH, Tzialidou I, Scharf A, Wenzlaff P, Maul H, Hillemanns P. Intrauterine fetal death in pregnancies of women with preconceptional and gestational diabetes mellitus and of women without glucose tolerance disorders. Results of the perinatal registry of Lower Saxony, Germany. Z GeburtshilfeNeonatol. 2006 ; 210(6):193-9.

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Published

2013-06-20

How to Cite

Arshad, R. ., Karim, N. ., & Azam, F. . (2013). Placental Morphology And Feto-Maternal Outcomes In Gestational Diabetes. Journal of Bahria University Medical and Dental College, 3(1), 30–33. Retrieved from https://jbumdc.bahria.edu.pk/index.php/ojs/article/view/51

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