Association between fetal vascular malperfusion and gestational diabetes

Abstract

Aim: Diabetes mellitus (DM) is a major complication in pregnancy. Placental lesions with DM remain unclear and controversial. Recently, the terms of placental pathological findings, such as maternal and fetal vascular malperfusions (MVM and FVM, respectively) were introduced by the Amsterdam Placental Workshop Group Consensus Statement (APWGCS). FVM cases were classified as the partial obstruction type (global FVM) and the complete obstruction type (segmental FVM). The aim of this study was to clarify the pathological characteristics of the placenta with pregestational DM/gestational DM; GDM according to APWGCS. Methods: We studied the placentas of 182 DM women (27 pregestational DM and 155 GDM) and control placentas of 460 women without DM during 2011-2018. We excluded cases of intrauterine fetal death or multiple pregnancies. We reviewed microscopical findings including, MVM, FVM, chorioamnionitis with the slides according to the APWGCS. Results: Microscopically, the incidence of FVM was significantly higher in GDM patients than control (17% vs. 10%, p = 0.0138), but not significant in pregestational DM (11%, p = 0.7410). Segmental FVM (complete obstruction) was significantly more observed in GDM than control group (5% vs. 0.4%, p = 0.0013). Segmental FVM in GDM showed high incidence of light-for-dates infant (three of seven cases, 43%, p = 0.0288). In addition, several segmental FVM findings (villous stromal-vascular karyorrhexis and stem vessel occlusion) were frequently noted in 2 or 3 points positive of 75 g oral glucose tolerance test than 1 point positive GDM. Conclusion: Our placental findings suggest disorder of carbohydrate metabolism might affect the fetal vascular damage, especially complete fetal vascular obstruction.

Comparative study of microvascular structural changes in the gestational diabetic placenta

“…Studies have shown that microvilli directly affect the uptake of nutrients and the excretion of metabolites between the placenta and the fetus. 17 Significant changes in microvilli size, morphology, and number are not conducive to normal fetal growth. Bedell et al 18 found that GDM causes villus immaturity, characterized by reduced terminal villus branches and an increased capillary count in the villi.…”

Placental recent/on-going foetal vascular malperfusion with endothelial fragmentation is diagnostically equivalent to established distal villous lesions of foetal vascular malperfusion

“…Our current material obtained in the Children's Hospital contained few hypertensive conditions of pregnancy, diabetes mellitus, infections, chronic FHR abnormalities, genetic thrombophilia, FGR, and oligohydramnios, i.e. the conditions known to be associated with FVM [28][29][30], but less frequently in our material than in UC compression [31]. Foetal growth restriction was reported to be associated with maternal background morbidities during pregnancy [32], representing a chronic repeated insult while "new" FGR cases (those following an appropriate for gestational age pregnancy) were characterized by a higher rate of FVM lesions and lower birth rate, probably representing "an accident" in placentation [33].…”

Stillbirth: prevention and supportive bereavement care

“…A possible explanation and mechanism is that inherited common thrombophilias combine with other conditions, such as glucose dysmetabolism and cord variations, causing stasis, hypercoagulability, and vessel damage (Virchow’s triad), increasing thrombosis in the fetal part of the placental circulation (fetal vascular malperfusion) and causing chronic or acute fetal hypoxia and death. 41 42 …”