Search

Introduction: One-fifth of pregnancies with pre-gestational diabetes mellitus (pre-DM) yield placentas <10th percentile small for gestational age (SGA), compared to a non-diabetic population. We hypothesized that SGA placentas of women with pre-DM, whether type I (T1DM) or type II (T2DM), exhibit distinct histopathological changes and pregnancy outcomes compared to pre-DM pregnancies with an AGA placenta.Methods: We conducted a retrospective, cohort study of placentas from pregnant women enrolled in the Diabetes in Pregnancy Program at Brown University between 2003 and 2011, by comparing pre-DM patients with SGA placentas to pre-DM patients with AGA placental weights.Results: The SGA placenta groups were associated with an increased risk for adverse clinical outcomes, compared to AGA placentas in pregnancies complicated by either T1DM or T2DM. Compared to their AGA pre-DM counterparts, T1DM, SGA placentas show increased peri-villous fibrin/fibrinoid deposition, thrombosis in fetal blood vessels, and meconium staining. Moreover, the histopathology of SGA placentas from T2DM is characterized by decidual vasculopathy, accelerated villous maturity, and erythroblastosis, compared to T2DM AGA placentas. The contrasting placental pathologies between the two pre-DM SGA phenotypes evolved independent of patient demographics and were unrelated to indicators of the glycemic control present at early gestational ages.Discussion: A sub-population of pre-DM women with either T1DM or T2DM diabetes that have an SGA placenta are at increased risk for adverse clinical outcomes in pregnancy, compared to pre-DM women with AGA placental weights. [ABSTRACT FROM AUTHOR]

Studies have demonstrated an association between pregestational diabetes (preGDM) and a higher prevalence of large-for-gestational age placentas (LGA). However, frequency of placental pathologies and perinatal outcomes in LGA placentas is lacking. We aimed to determine differences in perinatal outcome or placental pathology between LGA placentas and appropriate-for-gestational age (AGA) placentas from pregnancies complicated by preGDM. We found LGA placentas are associated with significantly higher neonatal weight but lower fetal-to-placental weight ratio (f/p) for both T1DM and T2DM. T2DM LGA placentas possessed a significantly higher prevalence of placental insufficiency (f/p<10 th percentile). Compared to LGA groups, more chronic villitis were seen in the AGA T2DM group, and more acute chorioamnionitis in the T1DM AGA group. No significant differences were seen in maternal BMI or glycemic control. In pregnancies complicated with preGDM, LGA placentas had generally lower placental efficiency than AGA placentas., (Copyright © 2019 Elsevier GmbH. All rights reserved.)