Abstract
ObjectiveTo investigate and compare the incidence of histopathological placental lesions in mild gestational hyperglycemia, gestational diabetes and overt diabetes at term and preterm gestation.Research design and methodsOne-hundred-and-thirty-one placental samples were collected from Diabetes mellitus (DM) positive screened patients. Two diagnostic tests, glycemic profile and 100 g oral glucose tolerance test (OGTT) in parallel identified 4 groups normoglycemic, mild gestational hyperglycemia (MGH), gestational DM (GDM) or overt DM (DM). Placental tissue specimens and sections from 4 groups were obtained by uniform random sampling and stained with hematoxylin-eosin.ResultsPlacentas from MGH group presented 17 types of histopathological change and higher rates of syncytial nodes and endarteritis. GDM placentas presented only nine types of histopathological change, high rates of dysmaturity, low rates of calcification and no syncytial nodes. Overt DM placentas showed 22 types of histopathological change, 21 of which were present in the preterm period. There were histopathological similarities between MGH and DM placentas, but the former exhibited a higher incidence of endarteritis, which has been described as a "post-mortem" phenomenon.ConclusionOur results confirmed that the distinct placental changes associated with DM and MGH depend on gestational period during which the diabetic insult occurs. It may reasonably be inferred that subclinical maternal hyperglycemia during pregnancy, as showed in MGH group, is responsible for increased placental endarteritis, a postmortem lesion in the live fetus.
Highlights
The placenta is a maternal-fetal organ that separates the maternal and fetal circulations and plays a central metabolic role in pregnancy
There were histopathological similarities between mild gestational hyperglycemia (MGH) and Diabetes mellitus (DM) placentas, but the former exhibited a higher incidence of endarteritis, which has been described as a “post-mortem” phenomenon
Our results confirmed that the distinct placental changes associated with DM and MGH depend on gestational period during which the diabetic insult occurs
Summary
The placenta is a maternal-fetal organ that separates the maternal and fetal circulations and plays a central metabolic role in pregnancy. The placenta of diabetic women has attracted much interest, primarily because it is thought that placental damage may be partially responsible for the high incidence of fetal complications in pregnancies complicated by Diabetes mellitus [1]. Increased amounts of glucose may reach the fetus by facilitated transport through the placenta [2]. The morphological and histopathological changes in Diabetes mellitus placentas are inconsistent and even somewhat controversial [1]. An attempt has been made to find a clinical-morphological correlation for manifest Diabetes mellitus, and for clinically latent disturbances of carbohydrate metabolism. The timing of departures from excellent glycemic control is critical in placental development and may affect diabetes-related changes in the placenta [5]
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