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A study of placental histological changes in gestational diabetes mellitus on account of fetal hypoxia

Geena Augustine, Mumtaz Pulikkathodi, Renjith S, Jithesh TK.

Abstract
Background: Diabetes in pregnancy has been associated with increased fetal growth and with a high risk of prenatal and postnatal complications. Metabolic impairments in maternal obesity and gestational diabetes mellitus (GMD) provoke an unusual commotion in peripheral blood and prompt vascular structure alterations, which affect the placental development and function. These fetal metabolic changes seem to be related to the duration of diabetes.

Objective: To find out placental histological changes in GDM, as the placenta is the regulator of nutrient composition and supply from mother to fetus and the source of hormonal signals that affect maternal and fetal metabolism, appropriate development of the placenta is crucial to healthy fetal development. Hypoxia has significant effects on placental development, causing hypercapillarization of the villous vasculature.

Materials and Methods: A prospective study was conducted comprising 58 subjects. The placenta was collected soon after delivery. After gross examination, placenta was processed for histological study.

Result: Placenta shows significant difference between the test and control group. There were significant microscopic findings. The area of GDM placenta is 219.65 31.34 and that of the normal placenta is 182.52 28.66. The thickness of GDM placenta is 3.15 0.40 and that of the normal placenta is 1.67 0.28. The circumference of GDM placenta is 52.32 3.70 and that of the normal placenta is 48.35 4.66. The diabetic placenta showed increased syncytial knots, fibrinoid necrosis, decreased vascular syncytial membrane, and chorangiosis.

Conclusion: Intrauterine hypoxia can cause cellular damage that occurs within the central nervous system. This study showed several significant morphological and histological differences in the placenta of the mother with GDM. These changes were absent in normal placenta. The assessment of various histological changes in the placenta on account of hypoxia in GDM is helpful for the retrospective explanations of complications in pregnancy.

Key words: Gestational diabetes mellitus, hyperglycemia, fetal hypoxia, placenta, chorangiosis



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