Placental morphology in different types of diabetes mellitus

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Abstract

AIM: The aim of this study was to compare placental morphological features from women with different types of diabetes mellitus considering method of DM correction.

MATERIALS AND METHODS: A retrospective, single-center, cohort study was carried out. We analyzed morphological examination results of 3300 placentas, which made uр the following comparison groups: type 1 diabetes mellitus on continuous subcutaneous insulin infusion (n = 60), type 1 diabetes mellitus on multiple subcutaneous insulin injections (n = 446), type 2 diabetes mellitus on diet (n = 95), type 2 diabetes mellitus on insulin therapy (n = 134), gestational diabetes mellitus on diet (n = 1652), gestational diabetes mellitus on insulin therapy (n = 735), preeclampsia (n = 39), and the control group (n = 139). The examined placentas were weighed, with their sizes (two diameters and thickness), cotyledon structure and defects assessed. We determined the umbilical cord junction and external characteristics of extraembryonic membranes. Fragments of the placenta (5 pieces) were fixed in 10% neutral buffered formalin (pH 7.2), processed with the Leica TP1020 tissue processor and embedded in paraffin. Histological sections (3-4 μm thick) were prepared and stained with hematoxylin-eosin. Statistical analysis was performed using the SPSS 23.0 and GraphPad Prism 8.0 software.

RESULTS: Following characteristics were typical for all types of diabetes mellitus: increased placental mass metrics, chronic placental insufficiency, dissociated villous maturation disorder with prevalent immaturity, as well as involutive-dystrophic and circulatory disorders of varying severity. Placentas from women with type 1 diabetes mellitus had the specific sings: the predominance of intermediate immature villi and stem villi stromal fibrosis. The frequency of placental infarcts and fibrinoid content in the intervillous space were comparable to those in placentas from women with type 2 diabetes mellitus. Inflammatory changes and moderate placental calcification were most consistently associated with type 2 diabetes mellitus, while gestational diabetes mellitus was characterized by “soft” damages. Placentas with preeclampsia showed higher prevalence of premature villous maturation, compensated placental insufficiency, and fibrinoid depositions in the intervillous and subchorionic spaces.

CONCLUSIONS: Understanding relationships between placental histological features and clinical aspects of diabetes mellitus makes it possible not only to clarify the pathophysiological processes occurring in this pathology but also to optimize the algorithm for the rational management of the neonatal period of children from mothers with diabetes mellitus.

About the authors

Roman V. Kapustin

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; Saint Petersburg State University

Author for correspondence.
Email: kapustin.roman@gmail.com
ORCID iD: 0000-0002-2783-3032
SPIN-code: 7300-6260
ResearcherId: G-3759-2015

MD, PhD

Russian Federation, 3 Mendeleevskaya line, Saint Petersburg, 199034

Ekaterina V. Kopteyeva

Saint Petersburg State University

Email: ekaterina_kopteeva@bk.ru
ORCID iD: 0000-0002-9328-8909
SPIN-code: 9421-6407

MD

Russian Federation, Saint Petersburg

Tatyana G. Tral

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Email: ttg.tral@yandex.ru
ORCID iD: 0000-0001-8948-4811
SPIN-code: 1244-9631
Scopus Author ID: 37666260400

MD, PhD

Russian Federation, 3 Mendeleevskaya line, Saint Petersburg, 199034

Gulrukhsor Kh. Tolibova

The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott; North-Western State Medical University named after I.I. Mechnikov

Email: gulyatolibova@yandex.ru
ORCID iD: 0000-0002-6216-6220
SPIN-code: 7544-4825
Scopus Author ID: 23111355700
ResearcherId: Y-6671-2018

MD, PhD, DSci (Medicine)

Russian Federation, 3 Mendeleevskaya line, Saint Petersburg, 199034; Saint Petersburg

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Supplementary files

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2. Fig. 1. Chronic placental insufficiency with a predominance of intermediate immature chorionic villi with hypervascularization and congestive plethora in type 1 DM. Staining with hematoxylin and eosin, ×100

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3. Fig. 2. Dissociated chronic placental insufficiency in type 2 DM. Staining with hematoxylin and eosin, ×100

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4. Fig. 3. Fibrinoid villous alteration in type 1 DM on multiple insulin injections. Staining with hematoxylin and eosin, ×100

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5. Fig. 4. Increased number of syncytial knots in type 1 DM. Staining with hematoxylin and eosin, ×200

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6. Fig. 5. Congestion of the vascular bed of intermediate and terminal chorionic villi in the placenta in GDM. Staining with hematoxylin and eosin, ×200

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7. Fig. 6. Hypoplastic form of chronic placental insufficiency. Staining with hematoxylin and eosin, ×100

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