Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Department of Obstetrics and Gynecology, Viborg Regional Hospital, Viborg, Denmark.
Placenta. 2018 Sep;69:20-25. doi: 10.1016/j.placenta.2018.06.309. Epub 2018 Jun 30.
Pregnancy complicated by diabetes mellitus (DM) is a central obstetric problem often complicated by fetal macrosomia and increased risk of intrapartum asphyxia. This risk might be explained by fetoplacental vascular abnormalities. This study aimed to investigate the fetoplacental vascular volume by placental CT angiography in normal pregnancies and in pregnancies complicated by type 1 DM (T1DM), diet controlled gestational DM (GDMd), and insulin treated gestational DM (GDMi).
Postpartum, barium contrast enhanced placental CT angiography was performed in 27 normal pregnancies and 25 DM pregnancies (8 T1DM, 8 GDMd, and 9 GDMi). The fetoplacental vascular volume/placenta weight (FVV/PW)-ratio and fetoplacental vascular volume/birth weight (FVV/BW)-ratio of each diabetic group were compared to the normal group with multiple regression analysis adjusted for GA. In all pregnancies a standardized histopathological placental examination was performed postpartum.
In normal pregnancies, the fetoplacental vascular volume increased with GA (p < 0.001), placental weight (p < 0.001), and birth weight (p < 0.001). In T1DM and GDMi pregnancies, the gestational age adjusted placental weight and the birth weight were increased when compared to normal pregnancies (p < 0.05). The FVV/BW-ratio was significantly reduced in both T1DM and GDMi pregnancies when compared to normal pregnancies (p = 0.003 and p = 0.009, respectively).
This study demonstrates, that in insulin treated DM pregnancies the fetus as well as the placenta is larger than normal. However, despite a large placenta, a relatively smaller fetoplacental vascular volume supplies the macrosomic fetus. This finding might explain why fetuses from insulin treated DM pregnancies have high vulnerability to intrauterine and intrapartum asphyxia.
妊娠合并糖尿病（DM）是一个主要的产科问题，常伴有胎儿巨大儿和分娩时窒息风险增加。这种风险可能与胎-胎盘血管异常有关。本研究旨在通过胎盘 CT 血管造影评估正常妊娠及 1 型糖尿病（T1DM）、饮食控制的妊娠期糖尿病（GDMd）和胰岛素治疗的妊娠期糖尿病（GDMi）孕妇的胎-胎盘血管容积。
产后，对 27 例正常妊娠和 25 例 DM 妊娠（8 例 T1DM、8 例 GDMd 和 9 例 GDMi）孕妇进行了含钡胎盘 CT 血管造影。用多元回归分析调整 GA 后，比较了每个糖尿病组的胎-胎盘血管容积/胎盘重量（FVV/PW）比值和胎-胎盘血管容积/出生体重（FVV/BW）比值与正常组的差异。所有妊娠均在产后进行了标准化的组织病理学胎盘检查。
在正常妊娠中，胎-胎盘血管容积随胎龄增加而增加（p<0.001），与胎盘重量（p<0.001）和出生体重（p<0.001）呈正相关。与正常妊娠相比，T1DM 和 GDMi 妊娠时，调整 GA 后的胎盘重量和出生体重增加（p<0.05）。与正常妊娠相比，T1DM 和 GDMi 妊娠时的 FVV/BW 比值明显降低（分别为 p=0.003 和 p=0.009）。
本研究表明，在胰岛素治疗的 DM 妊娠中，胎儿和胎盘均大于正常。然而，尽管胎盘较大，但供应巨大儿的胎-胎盘血管容积相对较小。这一发现可能解释了为什么胰岛素治疗的 DM 胎儿在宫内和分娩时易发生窒息。
