Differences in post‐mortem findings after stillbirth in women with and without diabetes. Issue 10 (24th July 2013)

• Record Type: Journal Article
• Authors: Edwards, A.; Springett, A.; Padfield, J.; Dorling, J.; Bugg, G.; Mansell, P.
• Is Part Of: Diabetic medicine. Volume 30:Issue 10(2013:Oct.)
• Page Start: 1219
• Page End: 1224
• Publication Date: 2013-07-24
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.12272
• Languages: English
• ISSNs: 0742-3071

Abstract

<abstract abstract-type="main" id="dme12272-abs-0001"> <title>Abstract</title> <sec id="dme12272-sec-0001" sec-type="section"> <title>Aims</title> <p>The reason for the fivefold increased risk of stillbirth in women with diabetes is not known. Further understanding of the underlying mechanisms may facilitate identification of pregnancies at increased risk. We have compared post‐mortem reports in matched pairs of stillbirths in women with and without diabetes.</p> </sec> <sec id="dme12272-sec-0002" sec-type="section"> <title>Methods</title> <p>Post‐mortem reports were provided by the Centre for Maternal and Child Enquiries. Stillbirths as a result of lethal congenital and genetic abnormalities were excluded. Whole body, placenta and organ weights and histo‐pathological findings in cases and controls were compared and also related to published reference values.</p> </sec> <sec id="dme12272-sec-0003" sec-type="section"> <title>Results</title> <p>We analysed post‐mortem reports on 23 matched pairs of stillbirths from 2009 to 2010. Mean placental weight in women with diabetes was 75 g less than in control subjects (95% CI −143 to −7 g; <italic>P</italic> = 0.032). In maternal diabetes, the thymus was often small and showed a 'starry sky' pattern on histology in 11 of 20 cases compared with four of 22 controls (<italic>P</italic> = 0.03). This histological finding was associated with a particularly low mean placental weight z‐score −2.1 (1.1) standard deviations below a reference population corrected for gestational age.</p> </sec> <sec id="dme12272-sec-0004" sec-type="section"> <title>Conclusions</title> <p>In over half of the stillbirths occurring in women with diabetes, there was a 'starry sky' appearance in the fetal thymus on histology, this being associated with a small placenta. These findings are consistent with a critical subacute metabolic disturbance being a prominent cause of the increased risk of stillbirth in pregnancies complicated by maternal diabetes.</p> </sec> </abstract>