Postpartum placental CT angiography in normal pregnancies and in those complicated by diabetes mellitus. (September 2018)

• Record Type: Journal Article
• Authors: Thunbo, Mette Østergaard; Sinding, Marianne; Bogaard, Pauline; Korsager, Anne Sofie; Frøkjær, Jens Brøndum; Østergaard, Lasse Riis; Petersen, Astrid; Sørensen, Anne
• Is Part Of: Placenta. Volume 69(2018)
• Page Start: 20
• Page End: 25
• Publication Date: 2018-09
• Subjects: Diabetes mellitus -- Placenta -- CT angiography -- Vasculature -- Fetoplacental vascular volume -- Gestational diabetes; CTA Computed tomography angiography -- DM diabetes mellitus -- GDMd diet controlled gestational diabetes mellitus -- FVV/BW-ratio fetoplacental vascular volume/birth weight-ratio -- FVV/PW-ratio fetoplacental vascular volume/placenta weight-ratio -- GA gestational age -- GDMi insulin treated gestational diabetes mellitus -- MRA magnetic resonance angiography -- T1DM type 1 diabetes mellitus; Placenta -- Periodicals; Reproduction -- Periodicals; Placenta -- Periodicals; Placenta -- Périodiques; Reproduction -- Périodiques; 612.63
• DOI: 10.1016/j.placenta.2018.06.309
• Languages: English
• ISSNs: 0143-4004

Abstract

Abstract: Introduction: Pregnancy complicated by diabetes mellitus (DM) is a central obstetric problem often complicated by fetal macrosomia and increased risk of intrapartum asphyxia. This risk might be explained by fetoplacental vascular abnormalities. This study aimed to investigate the fetoplacental vascular volume by placental CT angiography in normal pregnancies and in pregnancies complicated by type 1 DM (T1DM), diet controlled gestational DM (GDMd), and insulin treated gestational DM (GDMi). Methods: Postpartum, barium contrast enhanced placental CT angiography was performed in 27 normal pregnancies and 25 DM pregnancies (8 T1DM, 8 GDMd, and 9 GDMi). The fetoplacental vascular volume/placenta weight (FVV/PW)-ratio and fetoplacental vascular volume/birth weight (FVV/BW)-ratio of each diabetic group were compared to the normal group with multiple regression analysis adjusted for GA. In all pregnancies a standardized histopathological placental examination was performed postpartum. Results: In normal pregnancies, the fetoplacental vascular volume increased with GA ( p < 0.001), placental weight ( p < 0.001), and birth weight ( p < 0.001). In T1DM and GDMi pregnancies, the gestational age adjusted placental weight and the birth weight were increased when compared to normal pregnancies ( p < 0.05). The FVV/BW-ratio was significantly reduced in both T1DM and GDMi pregnancies when compared to normal pregnancies ( p = 0.003 and p = 0.009, respectively). Discussion: This study demonstrates, that in insulin treated DM pregnancies the fetus as well as the placenta is larger than normal. However, despite a large placenta, a relatively smaller fetoplacental vascular volume supplies the macrosomic fetus. This finding might explain why fetuses from insulin treated DM pregnancies have high vulnerability to intrauterine and intrapartum asphyxia. Highlights: Pregnancies complicated by diabetes (DM) are at high risk of intrapartum asphyxia. This risk may be related to fetoplacental vascular abnormalities. This study examines the fetoplacental vascular volume by placental CT angiography. In insulin dependent DM the fetoplacental vascular volume/birthweight-ratio is low. This finding might partly explain the higher vulnerability to fetal asphyxia.