Gestational hyperglycemia on diet and medication: impact on placental pathology and pregnancy outcomes

Background: To evaluate the placental morphology and perinatal outcome in patients with gestational hyperglycemia on diet and medication.Methods: Placental examinations performed at the Department of Pathology between August 2016 to August 2018 were retrospectively reviewed. Of the received 140 placentas, 35 of gestational diabetes (GDM) and pre gestational diabetes were identified and segregated into hyperglycemia on diet and on medication. The clinical details, placental findings and perinatal outcome of patients in both the groups (gestational hyperglycemia on diet and medication) were collected and analyzed.Results: Among the 35 cases, there were 24 cases of mild gestational hyperglycemia controlled with diet and 11 cases of hyperglycemia on medication (oral hypoglycemic drugs ± insulin).Most of the placentae in both the groups weighed less than tenth centile. The cord abnormalities such as hyper coiling, velamentous /marginal insertion and furcate cord were observed more in women with GDM on diet. There was no significant gross placental lesion in those on medication. Placental histological features most consistently associated with both the groups include, disturbances of villous maturation (DVM), Derangements in uteroplacental / foetoplacental circulation and villous capillary lesions. Small for gestational age and intrauterine foetal death were found in both the groups, but more commonly in patients with hyperglycemia on medication.Conclusions: Villous maturation defects, uteroplacental / foetoplacental malperfusion are the essential placental changes which can result in adverse perinatal outcomes in women with hyperglycemia irrespective of the diabetic control.

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Altered maternal metabolism during mild gestational hyperglycemia as a predictor of adverse perinatal outcomes: A comprehensive analysis

Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease ◽

10.1016/j.bbadis.2019.05.014 ◽

2020 ◽

Vol 1866 (2) ◽

pp. 165478 ◽

Cited By ~ 4

Author(s):

Marilza Vieira Cunha Rudge ◽

Angélica Mercia Pascon Barbosa ◽

Luis Sobrevia ◽

Rafael Bottaro Gelaleti ◽

Raghavendra Lakshmana Shetty Hallur ◽

...

Keyword(s):

Perinatal Outcomes ◽

Comprehensive Analysis ◽

Maternal Metabolism ◽

Mild Gestational Hyperglycemia ◽

Gestational Hyperglycemia ◽

Adverse Perinatal Outcomes

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Diagnostic protocol for gestational diabetes mellitus (GDM) (IADPSG/ADA, 2011): influence on the occurrence of GDM and mild gestational hyperglycemia (MGH) and on the perinatal outcomes

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-016-0200-2 ◽

2017 ◽

Vol 9 (1) ◽

Cited By ~ 9

Author(s):

Mariana Pinto Sirimarco ◽

Helena Maciel Guerra ◽

Eduardo Guimarães Lisboa ◽

Joice Monalisa Vernini ◽

Bianca Nicolosi Cassetari ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Perinatal Outcomes ◽

Diagnostic Protocol ◽

Mild Gestational Hyperglycemia ◽

Gestational Hyperglycemia

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Contributing Factors to Perinatal Outcome in Pregnancies with Gestational Diabetes—What Matters Most? A Retrospective Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10020348 ◽

2021 ◽

Vol 10 (2) ◽

pp. 348

Author(s):

Friederike Weschenfelder ◽

Friederike Hein ◽

Thomas Lehmann ◽

Ekkehard Schleußner ◽

Tanja Groten

Keyword(s):

Weight Gain ◽

Gestational Diabetes ◽

Perinatal Outcome ◽

Perinatal Outcomes ◽

Large For Gestational Age ◽

Obese Women ◽

Patient Counseling ◽

Contributing Factors ◽

Prepregnancy Bmi ◽

The Impact

The aim of diabetes care of pregnant women with gestational diabetes mellitus (GDM) is to attain pregnancy outcomes including rates of large-for-gestational-age (LGA) newborns, pre-eclampsia, C-sections (CS) and other neonatal outcomes similar to those of the non-GDM pregnant population. Obesity and excessive weight gain during pregnancy have been shown to also impact perinatal outcome. Since GDM is frequently associated with elevated body mass index (BMI), we evaluated the impact of maternal prepregnancy BMI, development of GDM and gestational weight gain (GWG) during pregnancy on perinatal outcome. We compared 614 GDM patients with 5175 non-diabetic term deliveries who gave birth between 2012 and 2016. Multivariate regression analysis was used to evaluate the independent contribution of each factor on selected perinatal outcome variables. Additionally, subgroup analysis for obese (BMI ≥ 30 kg/m2) and non-obese women (BMI < 30 kg/m2) was performed. LGA was significantly influenced by BMI, GWG and GDM, while Neonatal Intensive Care Unit (NICU) admission was solely impacted by GDM. Maternal outcomes were not dependent on GDM but on GWG and prepregnancy BMI. These results remained significant in the non-obese subgroup only. Thus, GDM still affects perinatal outcomes and requires further improvement in diabetic care and patient counseling.

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274: Association of the Pro12Ala polymorphism of PPARγ2 with mild gestational hyperglycemia and gestational diabetes

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2012.10.439 ◽

2013 ◽

Vol 208 (1) ◽

pp. S125 ◽

Cited By ~ 1

Author(s):

Kristin Taylor ◽

Paula Lima ◽

Rafael Gelaleti ◽

Mario Hirata ◽

Yuri Sinzato ◽

...

Keyword(s):

Gestational Diabetes ◽

Pro12ala Polymorphism ◽

Mild Gestational Hyperglycemia ◽

Gestational Hyperglycemia

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Uric Acid and Xanthine Levels in Pregnancy Complicated by Gestational Diabetes Mellitus—The Effect on Adverse Pregnancy Outcomes

International Journal of Molecular Sciences ◽

10.3390/ijms19113696 ◽

2018 ◽

Vol 19 (11) ◽

pp. 3696 ◽

Cited By ~ 1

Author(s):

Anna Pleskacova ◽

Vendula Bartakova ◽

Katarina Chalasova ◽

Lukas Pacal ◽

Katerina Kankova ◽

...

Keyword(s):

Diabetes Mellitus ◽

Uric Acid ◽

High Risk ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Perinatal Outcomes ◽

Anthropometric Parameters ◽

Pregnancy And Postpartum ◽

Adverse Perinatal Outcomes ◽

Adverse Pregnancy

Uric acid (UA) levels are associated with many diseases including those related to lifestyle. The aim of this study was to evaluate the influence of clinical and anthropometric parameters on UA and xanthine (X) levels during pregnancy and postpartum in women with physiological pregnancy and pregnancy complicated by gestational diabetes mellitus (GDM), and to evaluate their impact on adverse perinatal outcomes. A total of 143 participants were included. Analyte levels were determined by HPLC with ultraviolet detection (HPLC-UV). Several single-nucleotide polymorphisms (SNPs) in UA transporters were genotyped using commercial assays. UA levels were higher within GDM women with pre-gestational obesity, those in high-risk groups, and those who required insulin during pregnancy. X levels were higher in the GDM group during pregnancy and also postpartum. Positive correlations between UA and X levels with body mass index (BMI) and glycemia levels were found. Gestational age at delivery was negatively correlated with UA and X levels postpartum. Postpartum X levels were significantly higher in women who underwent caesarean sections. Our data support a possible link between increased UA levels and a high-risk GDM subtype. UA levels were higher among women whose glucose tolerance was severely disturbed. Mid-gestational UA and X levels were not linked to adverse perinatal outcomes.

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Perinatal outcome in gestational diabetes according to different diagnostic criteria

Journal of Perinatal Medicine ◽

10.1515/jpm-2019-0013 ◽

2019 ◽

Vol 47 (5) ◽

pp. 553-557 ◽

Cited By ~ 1

Author(s):

Lina Salman ◽

Anat Pardo ◽

Eyal Krispin ◽

Galia Oron ◽

Yoel Toledano ◽

...

Keyword(s):

Gestational Diabetes ◽

Perinatal Outcome ◽

Neonatal Intensive Care ◽

Challenge Test ◽

Perinatal Outcomes ◽

Tolerance Test ◽

Oral Glucose ◽

Neonatal Hypoglycemia ◽

Glucose Challenge ◽

Nicu Admission

Abstract Objectives To evaluate whether gestational diabetes mellitus (GDM) diagnosed by different criteria impacts perinatal outcome. Methods This was a retrospective study of deliveries with a diagnosis of GDM (2014–2016). Perinatal outcomes were compared between patients with: (1) GDM diagnosed according to a single abnormal value on the 100-g oral glucose tolerance test (OGTT); (2) two or more abnormal OGTT values; and (3) a 50-g glucose challenge test (GCT) value ≥200 mg/dL. Results A total of 1163 women met the inclusion criteria, of whom 441 (37.9%) were diagnosed according to a single abnormal OGTT value, 627 (53.9%) had two or more abnormal OGTT values and 95 (8.17%) had a GCT value ≥200 mg/dL. Diet-only treatment was significantly higher in the single abnormal value group (70.3% vs. 65.1% vs. 50.5%) and rates of medical treatment were significantly higher in the GCT ≥ 200 mg/dL group (P < 0.05). Women in the GCT ≥ 200 mg/dL group had higher rates of neonatal intensive care unit (NICU) admission (10.5% vs. 2.7% vs. 2.8%, P < 0.001) and neonatal hypoglycemia (5.3% vs. 0.5% vs. 0.8%, P < 0.001). On multivariate logistic regression, GCT ≥ 200 mg/dL was no longer associated with higher rates of NICU admission and neonatal hypoglycemia (P > 0.05). Conclusion No difference was noted in the perinatal outcome amongst the different methods used for diagnosing GDM.

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