COGI 2023

PREDICTORS OF PLACENTAL LESIONS IN PREGNANCIES COMPLICATED BY GESTATIONAL DIABETES MELLITUS

Chiara Dossi Hen Semiduberski Elisabetta Stucchi Anna Maria Veronelli Valentina Toto Veronica Iannuzzi Silvia Gherardi Martina Podda Sara Cella Rossella Prospero Damiana Cavallaro 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

To identify predictors of placental lesions in pregnancies complicated by GDM.

Methods

A prospective study was designed including pregnant women affected by GDM. Data were collected about demographics, pregnancy course, maternal and fetal outcomes, glycemic control, therapeutical approach. Analysis of placental findings was performed according to the updated criteria from Amsterdam Consensus.

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. 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. Likewise, placental weight in metformin group showed a lower weight if compared with diet and insulin, reducing cases of placentomegaly, typical feature of poor controlled GDM. By using updated classification criteria for histological evaluation of placenta, all placentas were studied and classified into four categories (maternal vascular malperfusion, fetal vascular malperfusion, acute and chronic inflammation). No differences were found among studies groups, while a slight reduction of inflammation in metformin group. By logistic regression analysis, associations between placental histological damage and maternal age, ethnicity, and treatment were explored. Both age and ethnicity failed to be associated with placental damage. In contrast, diet and insulin were found as risk factors, with odd ratio of 5.2 and 2.8 respectively. Metformin resulted a protective factor for placental damage reaching an OR of 0.2.

Conclusion

As an alerting obstetric complication, GDM could be prevent by both pregestational weight loss and lifestyle modification. Treatments are the best predictors of placental damage: metformin mitigates excessive pathological growth for fetus and placenta and seems to play an anti-inflammatory role in placenta. However, future studies are warranted for improving knowledge on action mechanism of current treatments for mother, baby, and placenta.

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