CLINICOPATHOLOGICAL COMPARISON OF HISTOPATHOLOGY OF PLACENTAE IN GESTATIONAL DIABETES MELLITUS COMPARED WITH THAT OF UNCOMPLICATED PREGNANCY AND PERINATAL OUTCOME IN GDM MOTHERS IN DIFFERENT INTERVENTIONS IN PREGNANCY

Main Article Content

Dr. Punyatoya Punyashree Sethy
Dr. Subhra Ghosh
Dr. Saumya Nanda
Dr. Mahija Sahu

Keywords

Clinicopathological Comparison, Histopathology, Placentae, Gestational Diabetes Mellitus, Perinatal Outcome

Abstract

Background: This Study Was Conducted To Study The Histopathology Of Placenta Complicated With Gdm With Placenta With Normal Pregnancy And To Compare The Perinatal Outcome In Gdm Cases With Different Treatment Types Of Interventions.


 Methods: This Was A Hospital-Based Prospective Case Control And Observational Study That Took Place From January 2020 To August 2021 In The Department Of Obstetrics And Gynaecology And Department Of Pathology, Scb Mch, Cuttack, Orissa. The Study Involved 50 Antenatal Mothers Who Were Diagnosed As Gdm In Opd And Labour Room. The Study Was Approved By The Institutional Ethics Committee, And The Participants Provided Written Informed Consent.


 Results: The Prevalence Of Gdm (P-Value < 0.002) Strongly Correlated With Increasing Age (Mean Age 29.38±3.09 Years, 86%, >25 Yrs.). Every Morphological Characteristic, Including The Number Of Cotyledons (Mean No. 18.72), Central Thickness (Mean 3.06 Cm), And Placental Weight (Mean Weight 646.58 G) (P-Value < 0.001), Was Statistically Significant. Maternal Decidual Vasculopathy (80%), Fibrinoid Necrosis Of Vessels (86%), Villous Edema (80%), Calcification (68%), Thickened Basement Membrane (100%), Syncytial Knot Formation (10%), And Villous Immaturity (84%), Chorangiosis (82%), Villous Fibrosis (82%), Intervillous And Perivillous Fibrin Deposits (82%), Were All Statistically Significant Histopathological Features. The Mode Of Delivery Did Not Differ Statistically Significantly Between The Groups (Lscs 46%, P-Value = 0.309). The Mean Birth Weight Of 3.50 Kg Demonstrated Statistical Significance, Nonetheless. Macrosomia (42%) And Hypocalcemia (40%) Were Reported To Be The Two Most Common Unfavorable Fetal Outcomes In Newborns With Gdm. Of The Patients With Gdm, 68% Followed A Diet Plan, 22% Received Insulin Along With A Diet Plan, And 10% Had Not Received Any Treatment At All. Both Macrosomia And Hypoglycemia Demonstrated Statistical Significance In All The Gdm Therapy Groups.


 Conclusion: Gdm Is More Common In Increasing Maternal Age. All Morphological Characters Like Weight Of Placenta, Central Thickness, Number In Cotyledons Except Diameter Of Placenta Are Increased In Gdm Which Is Statistically Significant. All The Histopathological Changes Are Also Statistically Significant. Perinatal Outcome In Unfavorable In Gdm Mothers Who Did Not Receive Any Therapy

Abstract 27 | pdf Downloads 21

References

1. American Diabetic Association: Report Of The Expert Committee On The Diagnosis And Classification Of Gestational Diabetes Mellitus. Diabetes Care 2003;26(1 Suppl):103-5.
2. Siddiqui S, Waghdhare S, Panda M, Sinha S, Singh P, Dubey S, Et Al. Regional Prevalence Of Gestational Diabetes Mellitus In North India. J Diabetol 2019;10(1):25-8.
3. Gestational Diabetes Mellitus. Current Guidelines For Diagnosis And Management Medicine Update 2010;20.
4. Kayal A, Anjana Rm, Mohan V. Gestational Diabetes-An Update From India. Diabetes Voice 2013;58(2):32-4.
5. Patric Mc. Diabetes Mellitus. In Reproductive Endocrinology, Surgery And Technology. Philadelphia Usa: Lippincott 1996.
6. Gauster M, Desoye G, Totsch M, Hiden U. The Placenta And Gestational Diabetes Mellitus. Curr Diab Rep 2012;12(1):16-23.
7. Calderon Im. Morphometric Study Of Placental Villi And Vessels In Women With Mild Hyperglycaemia Or Gestational Or Overt Diabetes. Diabetes Res Clin Pract 2007;78:65-71.
8. Jones Cj, Fox H. Syncytial Knots And Intervillous Bridges In The Human Placenta: An Ultra-Structural Study. J Anat 1977;124:275-86.
9. Saddler Yw. Placenta And Fetal Membrane. Longman’s Medical Embryology. Usa: Lippincott Williams And Wilkins 2004.
10. Singer Db. The Placenta In Pregnancies Complicated By Diabetes Mellitus. Perspect Peditr Pathol 1984;8(3):199-212.
11. Hanson Ui, Persson B. Outcomes Of Pregnancies Complicated By Type 1 Insulin – Dependent Diabetes In Sweden: Acute Pregnancies Complications, Neonatal Mortality And Morbidities. Am J Perinatol 1993;10(104):330-3.
12. Langer O, Yogev Y. Gestational Diabetes: The Consequences Of Not Treating. Am J Obstet Gynecol 2005;192:989-97
13. Gabbay-Benziv R, Baschat Aa. Gestational Diabetes As One Of The ”Great Obstetrical Syndromes”- The Maternal, Placental And Fetal Dialogue. Best Pract Res Clin Obstret Gynecol 2015;29(2):150-5.
14. Honda M, Toyoda C, Nakabayashi M, Omori Y. Quantitative Investigation Of Placenta Terminal Villi In Maternal Diabetes Mellitus By Scanning And Transmission Electron Microscopy. Tohoku J Exp Med 1992;167(4):247-57.
15. Laurini Rn, Visser Gh, Van Ballegooie E, Schoots Cj. Morphological Findings In Placenta Of Insulin Dependent Diabetic Patients Treated With Continuous Subcutaneous Insulin Infusion (Csii). Placenta 1987;8(2):153-65.
16. Thomsen K. Defective Development Of Young Placenta Villi. Arch Gynacol 1955;185(6):807-33.
17. Burstein R, Handler Fp, Soule Sd, Blumenthal Ht. Histogenesis Of Degenerative Processes In The Normal Mature Placenta. Am J Obstet Gynecol 1956;72(2):332-42.
18. Thomsen. Findings On Placental Morphology In Diabetes Mellitus. Acta Endocrinol (Copenh) 1958;29:602-14.
19. Stoj F, Scehumhmann Ra. Morphometric Investigation Of Terminal Villi Of Diabetic Placenta In A Relation To The White’s Classification Of Diabetes Mellitus. J Pernat Med 1987;15:193-8.
20. Younes B, Baez‐Giangreco A, Al‐Nuaim L, Al‐Hakeem A, Talib Za. Basement Membrane Thickening In The Placenta From Diabetic Women. Pathol Int 1996;46(2):100-4.
21. Al-Okail Ms, Al-Attas Os. Histological Changes In Placenta Syncytiotrophoblast Of Poorly Controlled Gestational Diabetes Patients. Endocr J 1994;41(4):355-60.
22. Kheir Ae, Berair R, Gulfan Ig, Karrar Mz, Mohammed Za. Morbidity And Mortality Amongst Infants Of Diabetic Mothers Admitted Into Soba University Hospital, Khartoum, Sudan. Sudanese Journal Of Paediatrics 2012;12(1):49-55.
23. Farooq Mu, Ayaz A, Bahoo La, Ahmad I. Maternal And Neonatal Outcomes In Gestational Diabetes Mellitus. Int J Endocrinol Metab 2007;5(3):109-15.
24. Elshennawy Tm, Halima Aa. Effect Of Gestational Diabetes On Gross Morphology, Histology And Histochemistry Of Human Placenta. Endocrinol Metab Synd 2016;5(1):1-13.
25. Wilczyński J, Podciechowski L, Krekora M, Wenerski J, Czichos E, Kulig A, Et Al. Macroscopic Estimation Of The Placenta Using A Morphometric Grid. Part I: Pre-Pregnancy And Post-Pregnancy Diabetes Mellitus. Ginekologia Polska 1998;69(12):974-81.
26. Evers Im, Nikkels Pg, Sikkema Jm, Visser Gh. Placental Pathology In Women With Type 1 Diabetes And In A Control Group With Normal And Large-For-Gestational-Age Infants. Placenta 2003;24(8-9):819-25.
27. Salge Ak, Rocha Km, Xavier Rm, Ramalho Ws, Rocha Él, Guimarães Jv, Et Al. Macroscopic Placental Changes Associated With Fetal And Maternal Events In Diabetes Mellitus. Clinics 2012;67(10):1203-8.
28. North Jr Af, Mazumdar S, Logrillo Vm. Birth Weight, Gestational Age, And Perinatal Deaths In 5,471 Infants Of Diabetic Mothers. J Pediatrics 1977;90(3):444-7.
29. Gabbe Sg, Mestman Jh, Freeman Rk, Goebelsmann Ut, Lowensohn Ri, Nochimson D, Et Al. Management And Outcome Of Pregnancy In Diabetes Mellitus, Classes B To R. Am J Obstet Gynecol 1977;129(7):723-9.
30. Kalhan Sc, Savin Sm, Adam Pa. Attenuated Glucose Production Rate In Newborn Infants Of Insulin-Dependent Diabetic Mothers. N Engl J Med 1977;296(7):375-6.
31. Makhseed M, Musini Vm, Ahmed Ma, Al-Harmi J. Placental Pathology In Relation To The White’s Classification Of Diabetes Mellitus. Arch Gynecol Obstet 2002;266:136-40.
32. Verma R, Mishra S, Kaul Jm. Cellular Changes In The Placenta In Pregnancies Complicated With Diabetes. Int J Morphol 2010;28(1):259-64.
33. Fox H. Fibrosis Of Placental Villi. J Pathol Bacteriol 1968;95(2):573-9.
34. Fox H. The Significance Of Villous Syncytial Knots In The Human Placenta. Bjog: An International Journal Of Obstetrics & Gynaecology 1965;72(3):347-55.
35. Gheorman L, Pleşea Ie, Gheorman V. Histopathological Considerations Of Placenta In Pregnancy With Diabetes. Rom J Morphol Embryol 2012;53(2):329-6.
36. Redline Rw. Distal Villous Immaturity. Mini Symphosium: Placental And Trophoblastic Pathology. Diagnost Histopathol 2012;18(5):189-94.
37. Paciencia M, Dolley P, Jeanne-Pasquier C, Jacob B, Sadfi A, Leseigneur P, Et Al. Acute Placental Dysfunction By Villous-Maturation Defect And Late-Fetal Mortality. J Gynecol Obstet Biol Reprod 2008;37(6):602-7.
38. Natarajan L, Maheswari Gu. Gestational Hyperglycemia On Diet And Medication: Impact On Placental Pathology And Pregnancy Outcomes. Int J Reprod Contracept Obstet Gynecol 2019;8:3350-6.
39. Tewari V, Tewari A, Bhardwaj N. Histological And Histochemical Changes In Placenta Of Diabetic Pregnant Females And Its Comparison With Normal Placenta. Asian Pacific Journal Of Tropical Disease 2011;1(1):1-4.
40. Saini P, Pankaj Jp, Jain A, Agarwal Gc. Effect Of Gestational Diabetes Mellitus On Gross Morphology Of Placenta: A Comparative Study. Int J Anat Res 2015;3(1):889-894.
41. Wasserman L, Shlesinger H, Abramovici A, Goldman Ja, Allalouf D. Glycosaminoglycan Patterns In Diabetic And Toxemic Term Placentas. Am J Obstet Gynecol 1980;138(7):769-73.
42. Evers Im, De Valk Hw, Visser Gh. Risk Of Complications Of Pregnancy In Women With Diabetes: Nationwide Prospective Study In Netherland. Bmj 2004;328(7445):915-9.
43. Yogev Y, Xenakis Em, Langer O. The Association Between Preeclampsia And The Severity Of Gestational Diabetes: The Impact Of Glycemic Control. Am J Obstet Gynecol 2004;191(5):1655-60.
44. Kalra P, Kachhwaha Cp, Singh Hv. Prevalence Of Gestational Diabetes Mellitus And Its Outcome In Western Rajasthan. Indian J E Endocrinol Metab 2013;17(4):677-80.