Histomorphological Study of Placenta in Gestational Diabetes Mellitus

Abstract

SUMMARY:Evidence from the literature shows that well-controlled glucose levels during pregnancy are usually associated with normal placental morphology. The aim of this study was to identify the placental changes attributed to maternal hyperglycemia. A total of 20 placentae were selected for study from a tertiary care medical center in Makkah city, Saudi Arabia. Out of 20, 10 placentae were from patients diagnosed with GDM based on IADSPG criteria, and 10 placentae were from patients with normal pregnancies without GDM. The morphometric measurements were recorded. The mean weight of GDM placentae were more than the normal placentae. Upon histopathology, significant changes such as syncytial knots, cytotrophoblastic cell proliferation, fibrinoid necrosis, stromal fibrosis, and hyalinized villi were observed in GDM placentae. GDM produces significant morphological alterations in the placentae, which might affect the developing fetus.

Histopathological Grading and Enzyme Histochemical Study of the Placenta in Gestational Diabetes Mellitus Pregnant Women

“…2B). This results matched with other studies that observed a histological change in GDM placentae represented by stromal fibrosis 6 Syncytial knots were formed in more than onethird of the examined villi, in 28 placentae (70 %) from the GDM group. However, this deviation from the normoglycemic group was noticed only in 4 placentae (20 %) (Fig.…”

“…This change was observed in the normoglycemic group in only 2 placentae (10 %), in the GDM group in 26 placentae (65 %). El Sawy et al 6 and other study 15 confirm that one of indicator of placentae tissue of GDMpregnant is cytotrophoblast cells proliferation 6 .…”

“…Other studies found that one of the pathological features of placentae in hyperglycemic pregnant women is villous oedema 12 . The intervillous distance was of various extent, but some of the distance was vast when compared with normal placentae resulting from intervillous oedema with the increased amount of fibrinoid 6 On the other hand, an excessive amount of collagen fibres in the stroma of the villi was easily demonstrated, stromal fibrosis was observed in 2 placentae (10%) of the normoglycemic group, but increased up to 23 placentae (57.5%) from GDM group, (Fig. 2B).…”

“…2 Diabetes occurs during the second trimester of pregnancy 3 , but most of it occurs in the third trimester of pregnancy, as the mother is likely to develop diabetes after childbirth, especially type-2 diabetes mellitus 4 . The causes of GDM in some women are not known in a specific way, but there are contributing factors in the occurrence of the disease, including the interference of the hormones required by the fetus's growth that is an obstacle to the work of insulin 5 , and that weight gain may lead to increased insulin resistance and insulin resistance will deprive the fetus of the benefit of the effect of insulin product 6 . The placenta during pregnancy produces additional amounts of the hormone (Cortisol) and other hormones that are anti-insulin, such as progesterone and human chorionic gonadotrophin and the human placental lactogen 7 .…”

O-GlcNAcylation in Hyperglycemic Pregnancies: Impact on Placental Function

“…Moreover, unbalanced O-GlcNAcylation levels favor endothelial dysfunction in uterine arteries, which is important for uteroplacental circulation and this is partly modulated by OGT (32). These results might partly explain the structural and functional immaturity of placentas exposed to hyperglycemia and its effect on maternal-fetal interactions (33).…”