COGI 2023

IMPACT OF DIFFERENT STRATEGIES OF TREATMENT FOR GESTATIONAL DIABETES MELLITUS ON PLACENTAL FINDINGS

Lucrezia Loda Hen Semiduberski Elisabetta Stucchi Anna Maria Veronelli Valentina Toto Veronica Iannuzzi Silvia Gherardi Martina Podda Sara Cella Rossella Prospero Damiana Cavallaro Chiara Dossi Anna Maria Marconi Stefania Triunfo
Department of Obstetrics and Gynecology, Milan, Italy, Asst Santi Paolo E Carlo, S. Paolo University Hospital, Universita' Degli Studi Di Milano,, Milan

Problem statement

Gestational diabetes mellitus is the most common metabolic disturbance during pregnancy. In last decades, the prevalence is rising, mainly due to the increase in maternal obesity and delayed the family planning, reaching an overall rate of 10-15%. Crucial short- and long-term health risks are described in the growing body of literature on this topic. Successful pharmacological interventions represent a fruitful goal for the modern public health. The aim of the present study was to assess effects of GDM treatments on placental histology.

Methods

A prospective study was designed including pregnant women affected by GDM. Analysis of placental findings was performed according to the updated criteria from Amsterdam Consensus. One-way ANOVA with linear polynomial orthogonal contrast or linear-by-linear association test X2 were used to test the hypothesis of linear trend across the study groups of quantitative and qualitative variables, respectively. Statistically significant p-value was set at <0.05.

Results

A total of 553 pregnancies complicated by GDM were included in the analysis (diet, n=391; insulin, n=94; metfomin, n=68, respectively). Demographics were similar among three study groups. No statistically significant linear tendency was found for maternal age, ethnicity, education, working status, smoking status, and marital status. A higher rate of labor induction was found in insulin group, mainly due to the established gestational age for delivery, fixed at ending 38-starting 39 weeks.

Metformin reduced rates of small and large babies in comparison with insulin, suggesting a better control of effects of hyperglycemias on birthweight in all cases requiring a pharmacological treatment. In metformin group placental weight was lower weight if compared with diet and insulin, with a significant reduction of placentomegaly, typical feature of poor controlled GDM. By using updated classification criteria for histological evaluation of placenta, no differences were found among studies groups. A significant slight reduction of inflammation was found in metformin group.

Conclusion

Management of GDM requires a multilevel approach for reducing adverse obstetric outcomes. Among therapeutic treatment, metformin seems to mitigate the excessive pathological growth for fetus and placenta.

Keywords: Pregnancy, diabetes, placenta, metformin, insulin, histology.