A systematic review of placental pathology in maternal diabetes mellitus

Abstract

During a pregnancy complicated by diabetes, the human placenta undergoes a number of functional and structural pathologic changes, such as increased placental weight and increased incidence of placental lesions including villous maturational defects and fibrinoid necrosis. The pathologic findings reported have differed among studies, potentially reflecting differences in type of diabetes, study methodology, or glycemic control of study participants. Alternatively, these discrepancies may represent different biologic adaptations to distinct metabolic diseases. In order to clarify these distinctions, we conducted a comprehensive review of English language citations in Pubmed and Embase using the keywords “diabetes”, “placenta”, AND “pathology”. Abstracts were reviewed for relevance then full-text articles were reviewed in order to extract a comprehensive summary of current pathological findings associated with pregestational and gestational diabetes mellitus, as well as an understanding of the impact of glycemic control on placental pathology. Placental abnormalities most consistently associated with maternal diabetes are an increased incidence of villous immaturity, increased measures of angiogenesis, and increased placental weight. The literature suggests that, despite similarities in placental abnormalities, differences in placental pathology may reflect differences in pathophysiology among different types of diabetes. Consequently, standardization of terminology used to define placental lesions is warranted. Moreover, further research is needed to investigate the impact of pathophysiology, glycemic control and clinical factors, such as infant sex, weight and race, on placental structure and function.

Histomorphological Study of Placenta in Gestational Diabetes Mellitus

“…Evidence from the literature shows that well controlled glucose levels during pregnancy are generally associated with normal placentae under light microscopy (Huynh et al, 2015).…”

Morfología de la Placenta en Recién Nacidos con Defecto Congénito

“…Una mayor frecuencia de inmadurez placentaria se ha reportado en otras condiciones como en placentas de RN prematuros con restricción del crecimiento fetal idiopática, malformaciones congénitas, anomalías cromosómicas o genéticas y de madres con diagnóstico de diabetes mellitus (Redline, 2012). Se ha sugerido que la inmadurez en las placentas de productos con DC múlti-ples pudiera ocurrir como un mecanismo de respuesta adaptativa ante las condiciones fetales desfavorables [defectos del tubo neural, cardiacos, osteomusculares y cromosómicos] (López et al; Jones et al; Castejón et al) o bien, como respuesta a procesos moleculares asociados al factor de crecimiento endotelial y al factor de crecimiento placentario (Jones et al) o por morbilidad materna pre-existente (Ruiz-Quiñonez et al; Huynh et al, 2015;Loardi et al).…”

Effect of dietary approaches to stop hypertension diet plan on pregnancy outcome patients with gestational diabetes mellitus

“…On all aspects of the management and treatment of patients with diabetes mellitus, nutritional therapy plays a very necessary role (Huynh et al, 2015).…”