Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Department of Diagnostic Pathology, Faculty of Medicine, Miyazaki University Hospital, University of Miyazaki, Miyazaki, Japan.
J Obstet Gynaecol Res. 2022 Jan;48(1):80-86. doi: 10.1111/jog.15046. Epub 2021 Nov 2.
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.
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.
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.
Our placental findings suggest disorder of carbohydrate metabolism might affect the fetal vascular damage, especially complete fetal vascular obstruction.
糖尿病（DM）是妊娠的主要并发症。DM 胎盘病变仍不清楚且存在争议。最近，由阿姆斯特丹胎盘工作组共识声明（APWGCS）引入了胎盘病理发现的术语，如母体和胎儿血管灌注不良（MVM 和 FVM）。FVM 病例分为部分阻塞型（全 FVM）和完全阻塞型（节段性 FVM）。本研究旨在根据 APWGCS 阐明孕前 DM/妊娠 DM；GDM 的胎盘病理特征。
我们研究了 182 例 DM 妇女（27 例孕前 DM 和 155 例 GDM）和 460 例无 DM 妇女的胎盘，排除了宫内胎儿死亡或多胎妊娠的病例。我们根据 APWGCS 回顾了包括 MVM、FVM、绒毛膜羊膜炎在内的显微镜下发现。
显微镜下，GDM 患者 FVM 的发生率明显高于对照组（17% vs. 10%，p=0.0138），但孕前 DM 患者无显著差异（11%，p=0.7410）。GDM 患者中节段性 FVM（完全阻塞）明显多于对照组（5% vs. 0.4%，p=0.0013）。GDM 中的节段性 FVM 显示出与胎龄不符的婴儿高发生率（7 例中有 3 例，43%，p=0.0288）。此外，与 1 点阳性 GDM 相比，2 点或 3 点阳性的 75g 口服葡萄糖耐量试验中，经常观察到几个节段性 FVM 发现（绒毛间质血管空泡变性和干血管闭塞）。
我们的胎盘发现表明碳水化合物代谢紊乱可能会影响胎儿血管损伤，尤其是完全性胎儿血管阻塞。
