Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Department of Obstetrics and Gynecology, Marshall Health, Huntington, WV.
J Matern Fetal Neonatal Med. 2022 Feb;35(3):486-494. doi: 10.1080/14767058.2020.1724944. Epub 2020 Feb 19.
To evaluate placental abnormalities in pregnancies affected by diabetes compared to unaffected pregnancies from a single academic center.
This is a retrospective cohort study of women with singleton gestations delivered at the University of Arkansas for Medical Sciences from 2007 to 2016. Pathologic examination of placentas from pregestational and gestational diabetic pregnancies were compared to placentas from patients without diabetes using 12 histologic elements. Maternal and neonatal outcomes were extracted from the medical record and compared between groups. Findings were adjusted for hypertensive disorders of pregnancy. Placental lesions were also correlated with diabetic control.
Pathology reports of 590 placentas along with corresponding medical records were reviewed. The diabetic group ( = 484) consisted of 188 patients with pregestational diabetes and 296 patients with gestational diabetes. The nondiabetic group consisted of 106 patients. The diabetic group was older, had a higher average BMI, and more hypertensive disorders ( < .0001). Out of the 12 histologic elements investigated, accelerated villous maturation (aOR = 8.45, 95%CI (1.13-62.95)) and increased placental weight (aOR = 3.131, 95% CI (1.558-6.293)) were noted to be significantly increased in placentas from diabetic pregnancies after controlling for hypertension. Intervillous thrombi were not significantly increased in pregnancies affected by diabetes. Neonates of the diabetic group were more likely to be large for gestational age ( < .0001) and had a higher rate of preterm delivery ( < .0001).
Accelerated villous maturation was found to be more frequent in pregnancies complicated by pregestational diabetes, even after controlling for hypertension. In pregnancies complicated by gestational diabetes, the placental findings were not significant after controlling for hypertension. In contrast with prior studies, there was no increase in thrombotic lesions of the placenta in patients with diabetes.
评估与无糖尿病影响的妊娠相比，单一学术中心中糖尿病影响的妊娠中的胎盘异常。
这是一项回顾性队列研究，纳入了 2007 年至 2016 年在阿肯色大学医学科学分校分娩的单胎妊娠妇女。使用 12 种组织学元素比较孕前和妊娠期糖尿病孕妇的胎盘病理检查与无糖尿病患者的胎盘。从病历中提取母婴结局并在组间进行比较。结果调整了妊娠高血压疾病的影响。还将胎盘病变与糖尿病控制进行了相关性分析。
共回顾了 590 份胎盘病理报告及其相应的病历。糖尿病组（n=484）包括 188 例孕前糖尿病患者和 296 例妊娠期糖尿病患者，非糖尿病组包括 106 例患者。糖尿病组年龄更大，平均 BMI 更高，且高血压疾病更多（<0.0001）。在所研究的 12 种组织学元素中，在控制高血压后，发现糖尿病妊娠胎盘的绒毛成熟加速（优势比[aOR]=8.45，95%可信区间[CI]：1.13-62.95）和胎盘重量增加（aOR=3.131，95%CI：1.558-6.293）显著增加。妊娠期糖尿病患者的绒毛间血栓无明显增加。糖尿病组新生儿更有可能为巨大儿（<0.0001），且早产率更高（<0.0001）。
即使在控制高血压后，也发现孕前糖尿病合并妊娠中绒毛成熟加速更为常见。在控制高血压后，妊娠期糖尿病合并妊娠中的胎盘发现无显著差异。与之前的研究相比，糖尿病患者的胎盘血栓病变无增加。
