Cellular Changes in the Placenta in Pregnancies Complicated with Diabetes

Abstract

Placenta is the most accurate record of the infant prenatal experience. After delivery if the placenta is examined minutely, it provides much insight into the prenatal health of the baby and the mother. In diabetic pregnancy, placental weight is higher in comparison to normal pregnancy. To study the cellular differences that might contribute to larger size of placenta, light microscopic analysis was performed on 25 full term placentas, out of which 20 were of Gestational diabetes mellitus (12 controlled on diet, 8 controlled on insulin) and 5 control group. Tissue sections were processed and analyzed. Birth weight of neonate, placental weight, vascular pattern of chorionic blood vessels and site of attachment of umbilical cord were recorded. In the placenta of diabetic pregnants, gross abnormalities were uncommon but microscopic examination exhibited, to a varying degree, lesions like syncytial knots, fibrinoid necrosis, villous edema, villous fibrosis and capillary proliferation. These findings indicate that control of hyperglycemia only partially prevents the development of placental abnormalities which must be due to some other constituent factor of diabetic state.

Placental Changes in Gestational Diabetes Controlled with Insulin versus Diet without Insulin Compared with Normal Uncomplicated Pregnancy: Clinical and Histopathological Study

“…Thismacrosmiamay be attributed to fetal hyperinsulenemia in response to hyperglycaemia infetuses of diabetic mothers [1,3,15]. The interesting point in the present study that, there are no significant differences of these parameters in GDM group controlled by diet without insulin and control group.Similar findings were reported inprevious study by Verma et al (2010) [8]. In the same track, several differences were identified in the lightmicroscopy of terminal villi from the placentae of GDM group controlled with insulin; large number of syncytial knots(Increased number of syncytiotrophoblastnuclei which showed chromatin clumping, a feature typical of senescence,and were usually arranged in clusters known as syncytialknots as defined by Jone& Fox, 1977 [11]),fibrinoid necrosis, villous edema, villous fibrosis andproliferation of the capillaries.While placentas of GDMgroup controlled with diet alone without insulin showed minimally increased number of syncytialknots,fibrinoid necrosisand none of them showed villous edema,villous fibrosis or fetal capillary proliferationresemblingmore to the control group.More or less similar results were found in previous old studies (16,17) where they found in addition fibrin necrosis and thickening of basal membrane of trophoblast in the placentaof poorly controlled diabetes.In our study, all the patients were perfectly controlled whatever the used modality with insulin or without.…”

“…In the present study, the mean placental weight, the mean placental diameter, the mean placental central thickness and the mean placental surface area in GDM group controlled with insulin was more as compared to control group and this difference was found highly significant (p < 0.01). Similar findings were reported inprevious studies by Verma et al (2010) [8],Chowdhury et al (2011) [13] and Saha et al (2014) [14]. The weight gain in placentae ofdiabetic mothers may be attributed tomacrosomia andcompensatory hyperplasia.Macrosomia affects the fetus and fetal part ofplacenta.…”

“…Also the degree of control and the modality used in control either with insulin or diet alone should be taken in consideration. So it is therefore not surprising that the result obtainedhave been inconsistent and indeed, often contradictory [8]. In our study, all the patients with GDM were perfectly controlled whatever the modality Licensed Under Creative Commons Attribution CC BY of treatment with insulin or without.…”

“…These abnormalities of the placenta may lead to adverse fetal outcome [12].Reports on the pathology of placenta in GDM are numerous but often contradictory. Theinconsistency may be explained in part, by the fact that thecategories of diabetic pregnant women are very heterogeneous [8].The delineation of placental lesions in maternal diabetes hasbeen also made unduly complex by the superimposedhypertension and other associated complications. In thepresent study, all the patients with GDM were perfectly controlled whatever the modality of treatment with insulin or without.…”

Clinical correlation with pathology of placenta in medical disorders of pregnancy and its comparison in normal pregnancy

“…11 Marilza VC et al found mean birth weight 3490 gms. In the present study mean birth weight was 3560 gm.…”