365: Pregnancy outcome and placental pathology in gestational and pre-gestational diabetes mellitus compared with non-diabetic controls with and without hypertensive complications

Abstract

To compare pregnancy outcome and placental pathology in pregnancies complicated by diabetes mellitus (DM), GDMA1 and A2 and pre-gestational (PGDM) with matched non-diabetic controls. Pregnancy outcome and placental pathology from term pregnancies with DM complicated with hypertensive disorders (DM-H) were compared with non-diabetic hypertensive controls (control-H), matched by mode of delivery, from 2007-2012. Data were also compared between DM patients without hypertensive disorders (DM) and healthy controls (control). Neonatal outcome parameters included mean cord pH, and ICU admission rate. Composite neonatal outcome was defined as one or more of early complications: respiratory distress or need of ventilation support, hypoglycemia, phototherapy, transfusion, hypoxic-ischemic encephalopathy. Placental lesions were classified as lesions of maternal and fetal vascular supply and maternal and fetal inflammatory responses. A total of 228 patients included. DM-H patients (n=51) had higher birthweight as compared with control-H group (n=51). Composite neonatal outcome and rate of placental maternal and fetal vascular lesions did not differ between the groups. DM patients without hypertensive complications (DM, n=177)) had higher maternal age, rate of induction of labor, and birth weight compared to controls, p=0.032, p<0.001, p=0.037, respectively. Worse composite neonatal outcome was observed in the DM group compared to healthy controls, 24.3% vs. 15.2% respectively, p=0.032. Higher rate of placental maternal vascular lesions and distal villous immaturity were demonstrated in the DM vs. control group, p=0.004, p=0.014, respectively. Worse neonatal outcome and higher rate of placental vascular lesions express underlying placental pathology in diabetic women. High background rate of placental vascular lesions in hypertensive disorders, may explain the lack of difference between DM-H and controls-H.