Starikov R, Inman K, Chen K, Lopes V, Coviello E, Pinar H, He M
Washington Hospital Center, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 106 Irving Street Suite 108, Washington, DC 20010, USA; Women and Infants Hospital of Rhode Island, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 101 Dudley Street 3rd Floor, Providence, RI 02905, USA.
Women and Infants Hospital of Rhode Island, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 101 Dudley Street 3rd Floor, Providence, RI 02905, USA.
Placenta. 2014 Dec;35(12):1001-6. doi: 10.1016/j.placenta.2014.10.008. Epub 2014 Oct 22.
The aim of this study is to compare placental pathology and related clinical parameters between gravidas with type 1 and type 2 pregestational diabetes.
This is a retrospective cohort study of women with singleton gestations and pregestational diabetes who delivered at Women and Infants Hospital from 2003 to 2011. Pathology reports, maternal and neonatal outcomes were extracted and compared between the two groups.
In our cohort, 293 pregnancies were studied, including 117 with type 1 diabetes and 176 with type 2 diabetes. Women with type 1 diabetes had worse glycemic control during pregnancy, as characterized by higher HbA1c values and average fasting and postprandial blood sugars. More infants from the type 1 group were admitted to Neonatal ICU. Pregestational diabetes led to small for gestational age (SGA) placentas in nearly 20% pregnancies and large for gestational age (LGA) placentas in 30% of cases. Both groups shared similar incidences of preeclampsia and significant placental pathology related to uteroplacental (maternal) and fetal circulatory disorders; however, maternal decidual vasculopathy and placentas with insufficiency (fetal-to-placental weight ratio < 10th %tile) were more commonly found in placentas from women with type 2 diabetes.
Both types of pregestational diabetes have significant impact on placental growth and development. The comparison between the two groups suggests different pathogenetic mechanisms and may be helpful for better management of diabetic pregnancy.
本研究旨在比较孕前1型糖尿病和2型糖尿病孕妇的胎盘病理学及相关临床参数。
这是一项对2003年至2011年在妇女儿童医院分娩的单胎妊娠且患有孕前糖尿病的女性进行的回顾性队列研究。提取并比较两组的病理报告、母婴结局。
在我们的队列中，共研究了293例妊娠，其中117例为1型糖尿病，176例为2型糖尿病。1型糖尿病女性在孕期血糖控制较差，表现为糖化血红蛋白值较高，空腹和餐后血糖平均值较高。1型糖尿病组更多婴儿入住新生儿重症监护病房。孕前糖尿病导致近20%的妊娠出现小于胎龄儿（SGA）胎盘，30%的病例出现大于胎龄儿（LGA）胎盘。两组子痫前期的发生率以及与子宫胎盘（母体）和胎儿循环障碍相关的显著胎盘病理学发生率相似；然而，2型糖尿病女性的胎盘更常见母体蜕膜血管病变和胎盘功能不全（胎儿与胎盘重量比<第10百分位数）。
两种类型的孕前糖尿病对胎盘生长发育均有显著影响。两组之间的比较提示了不同的发病机制，可能有助于更好地管理糖尿病妊娠。
