Placental Changes in Gestational Diabetes Controlled with Insulin versus Diet without Insulin Compared with Normal Uncomplicated Pregnancy: Clinical and Histopathological Study

The fetus, placenta and mother constitute a triad of contributors to pregnancy outcome. Whenpregnancy is complicated by a medical problem like, diabetes mellitus which affects maternal health, architecture and functions of the placenta may even jeopardize the fetal normalcy. The placenta being the bridge between maternal and fetal activities, considered as a window through which maternal dysfunctions and their impacts on fetal well being can be understood. The aim of this research is studying the pathological changes of placentae of women with gestational diabetes mellitus and to compare the results with normal pregnancies. Methods It was an observational study conducted in Zagazig University hospitals, 20 placentae from pregnant women clinically diagnosed with gestational diabetes mellitus (GDM) controlled only with diet and life style modifications and another 20 placentae from pregnant women clinically diagnosed with gestational diabetes mellitus (GDM) controlled with insulin and 20 placentae from uncomplicated normal pregnant women were collected from labour room and operation theatre of department of obstetrics and gynaecology. Confirmed gestational diabetic cases were selected purposively from gestational diabetes clinic of endocrinology unit while controls were taken sequentially. Pathologic features of each placenta were recorded in histopathology department. ResultsThe results showed that placental weight, diameter, surface area and central thickness from diabetic mothers controlled with insulin were significantly more than diabetic mothers controlled only by diet or mothers of normal uncomplicated pregnancies, while no significant differences were observed in shape and site of umbilical cord insertion. The terminal villi in placentae of GDM controlled by insulin showed a significant varying degreeof changes like, the increased number of syncytial knots, villous edema and fibrinoid necrosis however, these changes were very minimal in cases of GDM treated only with diet and controlled without need of insulin. Conclusion The placentae of women with gestational diabetes mellitus treated with insulin even controlled show significant variation in gross morphology and light microscopy that can be associated with impaired function of placenta, leading to possible adverse perinatal outcome. In the other hand, the placentae of women with gestational diabetes mellitus controlled with diet alone showed minimal changes with no significant differences from normal uncomplicated pregnancy. Control of GDM or better prevention by education, diet, optimum weight control and life style modifications should be strictly encouraged and insulin use should be the last resort.