Uteroplacental Unit Disorders and Perinatal Outcomes in Pregnancies Complicated by Diabetes and Obesity

J. A. Marin, M. Russu, C. I. Târgovişte

Abstract: To assess the uteroplacental alterations and maternofetal outcomes in pregnancies complicated by diabetes (gestational, type 1 or type 2) and / or maternal obesity. The retrospective study on a representative sample of 14,400 births in a period of six years (2003-2008) examined all cases with diabetes - 153 (1.06%) cases and 225 controls. The main outcomes assessed were gestational age, birth weight, Apgar score and maternal and neonatal morbidity. A second analysis on 148 livebirths was done to identify microscopic placental alterations in diabetic and obese patients. There was a particular dispersion of types of diabetes in pregnancy: gestational diabetes 52%, type 1 DM -40% and type 2 diabetes - about 7%. Diabetic women presented an increased age at birth and a significantly higher prepregnancy weight (p <0.01), the blood pressure, it is statistically higher, and caesarean section rate is much higher. Neonate’s birthweight is significantly higher, and the Apgar score is lower than control. In obese patients was noted an increased maternal age and value of BP compared to control. Association of obesity increases the risk for hypertension, diabetes, overweight load, lower gestational age at birth, macrosomia, and lower Apgar score. Analysis of placenta showed a variety of macroscopic aspects - edema, congestion, and fibrinoid deposits calcification, characteristic but nonspecific for pregnancy with diabetes. These data confirm the higher incidence of neonatal morbidity by increased risk of metabolic, respiratory, hematological complications as well as fetal trauma, complications of intrauterine growth anomalies. This study confirms the role of uteroplacental histological abnormalities in diabetic pregnancies.
Keywords: gestational diabetes, obesity, hypertension, pregnancy