Spiral Artery Lesions in Relation to Metabolic Control in Diabetes Mellitus

Abstract

Decidual and intramyometrial spiral arteries from 18 insulin-dependent diabetic and 18 non-diabetic women were compared histologically. All women were normotensive and none had signs of pre-eclampsia. None of the infants in either group had intra-uterine growth retardation. Metabolic control in the diabetic women was assessed by pregnancy glucose level from the last trimester of pregnancy and by C-peptide in amniotic fluid and cord blood as a measure of the fetal beta-cell function. The intramyometrial and decidual parts of the spiral artery were normal in the non-diabetic group. None of the diabetic patients showed pathological changes in the intramyometrial part of the spiral artery. Two of the 18 diabetic patients had pathological changes (intramural fibrosis) in the decidual portion of the spiral artery. These two women had signs of diabetic angiopathy (White's class D and F) and in one of them, the background diabetic retinopathy progressed markedly during pregnancy. The pregnancy glucose level was above normal (greater than 6.2 mM/l) in 3 of 18 diabetics. The C-peptide values in amniotic fluid and cord blood were above normal in 11 of 17 and in 5 of 17, respectively. Both patients with spiral artery lesions had pregnancy glucose levels in the upper range, 5.86 and 5.98 mM/l, respectively and the highest value of C-peptide in the amniotic fluid and cord blood, suggesting exaggerated fetal beta-cell function.

The potential effects of pomegranate peel extract and bee venom in improving the diabetes induced damaging of spiral artery

“…They undergo remodeling during gestation, directed by natural maternal killer cells and invasive trophoblast lineages derived from embryos [14]. The present fi ndings were consistent with Bjork, et al, [13], whom reported two of the 18 diabetic patients showed Abnormal spiral artery was also detected in 69/203 of obese cases (33.9%) [24].…”

“…Two of the 18 diabetic patients developed intramural fi brosis in the decidual portion of the spiral artery. Hyperglycaemia and abnormal level of C-peptide values in amniotic fl uid and cord blood had been infl uenced in the induction of spiral artery lesions [13] The Pomegranate fruit's peel, seeds and juice are rich in antioxidants Pomegranate (Punica granatum L.), Punica granatum Linn. (Family , Punicaceae ), is commonly known as pomegranate.…”

The Human Placenta in Diabetes and Obesity: Friend or Foe? The 2017 Norbert Freinkel Award Lecture

“…The detailed mechanisms of placental responses also remain to be determined. This is a complex endeavor, because trophoblast invasion and, hence, spiral artery remodeling may be modified by maternal obesity (10) and diabetes (11).…”

Circulatory and renal consequences of pregnancy in diabetic NOD mice

“…SA remodeling is thought to transform this arterial tree to a high capacity, low resistance conduit that is unresponsive to vasoactive substances and thus provides continuous placental perfusion. In human pregnancies complicated by diabetes, placental insufficiency is seen more frequently, implicating inadequate remodeling of SA [11,12].The NOD mouse is a well-established model of autoimmune T1DM that shares several diabetes-susceptibility genes with humans. NOD mice spontaneously develop overt diabetes after 12 weeks of age.…”