Pregnancy outcome and placental pathology differences in term gestational diabetes with and without hypertensive disorders

Abstract

Objective: To compare pregnancy outcome and placental pathology in pregnancies complicated by gestational diabetes mellitus (GDM A1 and A2), with and without hypertensive disorders. Methods: Pregnancy outcome and placental pathology from term deliveries of women complicated with GDM with (GDM + H) and without (GDM − H) hypertensive disorders were compared. Results of the GDM + H group were compared also with the non-diabetic patients but with hypertensive disorders (non-GDM + H). Composite neonatal outcome was defined as one or more of early complications: respiratory distress or need of ventilation support, sepsis, phototherapy, transfusion, seizure, hypoxic-ischemic encephalopathy. Placental lesions were categorized to lesions related to maternal and fetal vascular supply abnormalities, and maternal and fetal inflammatory responses. Results: Of the 192 women with GDM, the GDM + H group (n = 41) were more obese, p < 0.001, with higher rate of placental maternal and fetal vascular supply lesions, p = 0.008, p = 0.03, respectively, but similar neonatal outcome, compared to the GDM − H (n = 151) group. Compared to the non-GDM + H group (n = 41), the GDM + H group had higher birth weights, similar neonatal outcome and similar rate of placental vascular lesions. Conclusions: Higher rate of placental maternal and fetal vascular supply lesions express underlying placental pathology in women with diabetes and hypertensive disorders, similar to women without DM and with hypertensive complications.