Department of Obstetrics and Gynecology, Western University, London, Canada.
Department of Obstetrics and Gynecology, Western University, London, Canada; Children's Health Research Institute, Western University, London, Canada.
Placenta. 2023 May;136:18-24. doi: 10.1016/j.placenta.2023.02.008. Epub 2023 Feb 24.
We determined the impact of gestational diabetes (GDM) and pre-existing diabetes (DM) on birth/placental weight and cord oxygen values with implications for placental efficiency and fetal-placental growth and development.
A hospital database was used to obtain birth/placental weight, cord PO and other information on patients delivering between Jan 1, 1990 and Jun 15, 2011 with GA >34 weeks (N = 69,854). Oxygen saturation was calculated from the cord PO and pH data, while fetal O extraction was calculated from the oxygen saturation data. The effect of diabetic status on birth/placental weight and cord oxygen values was examined adjusting for covariates.
Birth/placental weights were stepwise decreased in GDM and DM compared to non-diabetics with placentas disproportionally larger indicating decreasing placental efficiency. Umbilical vein oxygen was marginally increased in GDM but decreased in DM attributed to the previously reported hyper-vascularization in diabetic placentas with absorbing surface area of capillaries initially increased, but then constrained by increasing distance from maternal blood within the intervillous space. Umbilical artery oxygen was unchanged in GDM and DM, with fetal O extraction decreased in DM indicating that fetal O delivery must be increased relative to O consumption and likely due to increased umbilical blood flow.
Increased villous density/hyper-vascularization in GDM and DM with placentas disproportionately larger and umbilical blood flow increased, are postulated to normalize umbilical artery oxygen despite increased birth weights and growth-related O consumption. These findings have implications for mechanisms signaling fetal-placental growth and development in diabetic pregnancies and differ from that reported with maternal obesity.
我们确定了妊娠糖尿病（GDM）和原有糖尿病（DM）对出生/胎盘重量和脐带氧值的影响，这对胎盘效率以及胎儿-胎盘生长和发育有重要意义。
我们使用医院数据库获取了 1990 年 1 月 1 日至 2011 年 6 月 15 日期间分娩且 GA 大于 34 周（N=69854）的患者的出生/胎盘重量、脐带 PO 及其他信息。我们根据脐带 PO 和 pH 值数据计算氧饱和度，根据氧饱和度数据计算胎儿 O 摄取量。通过调整协变量来检验糖尿病状态对出生/胎盘重量和脐带氧值的影响。
与非糖尿病患者相比，GDM 和 DM 患者的出生/胎盘重量逐渐降低，而胎盘比例增大，表明胎盘效率降低。GDM 患者的脐静脉氧略有增加，而 DM 患者的脐静脉氧减少，这归因于先前报道的糖尿病胎盘的高血管化，其毛细血管吸收表面积最初增加，但随后由于与母体血液的距离增加而受到限制，在绒毛间隙内。GDM 和 DM 患者的脐动脉氧无变化，DM 患者的胎儿 O 摄取减少，表明胎儿 O 输送必须相对于 O 消耗增加，这可能是由于脐血流量增加所致。
GDM 和 DM 患者的绒毛密度/高血管化增加，胎盘比例增大，脐血流量增加，据推测尽管出生体重和与生长相关的 O 消耗增加，但脐动脉氧仍能正常化。这些发现对糖尿病妊娠中胎儿-胎盘生长和发育的信号机制有重要意义，与肥胖母亲报告的结果不同。
