Siassakos Dimitrios, Bourne Isabella, Sebire Neil, Kindinger Lindsay, Whitten Sara Melissa, Battaglino Clarissa
Institute for Women's Health, University College London, London, UK.
University College London Hospital (UCLH), London, UK.
J Perinat Med. 2022 Apr 1;50(6):763-768. doi: 10.1515/jpm-2021-0579. Print 2022 Jul 26.
In the UK one in 250 pregnancies end in stillbirth. Abnormal placental villous maturation, commonly associated with gestational diabetes, is a risk factor for stillbirth. Histopathology reports of placental distal villous immaturity (DVI) are reported disproportionately in placentas from otherwise unexplained stillbirths in women without formal diagnosis of diabetes but with either clinical characteristics or risk factors for diabetes. This study aims to establish maternal factors associated with DVI in relation to stillbirth.
Placental histopathology reports were reviewed for all pregnant women delivering at University College London Hospital between July 2018 to March 2020. Maternal characteristics and birth outcomes of those with DVI were compared to those with other placental lesions or abnormal villous maturation.
Of the 752 placental histopathology reports reviewed, 11 (1.5%) were reported as diagnostic of DVI. Eighty cases were sampled for clinical record analysis. All women with DVI had normal PAPP-A (>0.4 MoM), normal uterine artery Doppler studies (UtA-PI) and were normotensive throughout pregnancy. Nearly one in five babies (2/11, 18.5%) with DVI were stillborn and 70% had at least one high glucose test result in pregnancy despite no formal diagnosis of diabetes.
These findings suggest that the mechanism underlying stillbirth in DVI likely relates to glucose dysmetabolism, not sufficient for diagnosis using current criteria for gestational diabetes, resulting in placental dysfunction that is not identifiable before the third trimester. Relying on conventional diabetes tests, foetal macrosomia or growth restriction, may not identify all pregnancies at risk of adverse outcomes from glucose dysmetabolism.
在英国，每250例妊娠中有1例以死产告终。胎盘绒毛成熟异常通常与妊娠期糖尿病相关，是死产的一个危险因素。在未正式诊断为糖尿病但有糖尿病临床特征或危险因素的女性中，胎盘远端绒毛不成熟（DVI）的组织病理学报告在不明原因死产的胎盘中报告比例过高。本研究旨在确定与死产相关的母体因素与DVI的关系。
回顾了2018年7月至2020年3月在伦敦大学学院医院分娩的所有孕妇的胎盘组织病理学报告。将DVI患者的母体特征和出生结局与其他胎盘病变或绒毛成熟异常患者进行比较。
在752份回顾的胎盘组织病理学报告中，11份（1.5%）被诊断为DVI。抽取80例进行临床记录分析。所有DVI女性的妊娠相关血浆蛋白A（PAPP-A）均正常（>0.4 MoM），子宫动脉多普勒检查（UtA-PI）正常，且整个孕期血压正常。近五分之一（2/11，18.5%）患有DVI的婴儿为死产，70%的孕妇在孕期至少有一次血糖检测结果偏高，尽管未正式诊断为糖尿病。
这些发现表明，DVI死产的潜在机制可能与葡萄糖代谢异常有关，目前妊娠期糖尿病的诊断标准不足以诊断，导致胎盘功能障碍，在孕晚期之前无法识别。依靠传统的糖尿病检测、巨大儿或生长受限可能无法识别所有有葡萄糖代谢异常不良结局风险的妊娠。
