Type 1, type 2 and gestational diabetes mellitus differentially impact placental pathologic characteristics of uteroplacental malperfusion.
Type 1, type 2 and gestational diabetes mellitus differentially impact placental pathologic characteristics of uteroplacental malperfusion.
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类型1，类型2和妊娠糖尿病对子宫内灌注的胎盘病理特征有差异影响。
DOI：
10.1016/j.placenta.2015.08.004
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发表时间：
2015-10
期刊：
影响因子：
3.8
通讯作者：
Bentley-Lewis R
中科院分区：
文献类型：
--
作者：
Huynh J;Yamada J;Beauharnais C;Wenger JB;Thadhani RI;Wexler D;Roberts DJ;Bentley-Lewis R
在妊娠合并糖尿病期间，胎盘会经历许多功能和结构病理变化。然而，不同研究之间的差异可能反映了所研究的糖尿病类型的病理生理学差异。我们检查了 18-40 岁、自我认定种族/民族的女性的胎盘病理学；单身，活产； 1 型（T1DM；n=36）、2 型（T2DM；n=37）或妊娠期糖尿病（GDM；n=126）。临床数据是从病历中提取的。胎盘诊断由围产期病理学家独立重新审查。进行了调整种族、妊娠体重增加、胎龄和收缩压的多变量分析。与 T2DM 或 GDM 相比，T1DM 女性的妊娠期体重增加（平均值 ± SD，T1DM 与 T2DM：28.5 ± 12.4 vs. 20.5 ± 13.4 kg，p=0.03；或 GDM：21.3 ± 12.7 kg，p=0.009）和胰岛素使用率更高（T2DM：100.0% vs. 85.3%，p=0.02；或GDM：4.0%，p<0.001）。在单变量分析中，与 T2DM 或 GDM 女性相比，T1DM 女性的胎盘梗塞患病率也同样较低。然而，经过多变量调整后，这些发现并不仍然显着。此外，与 GDM 相比，T2DM 女性的胎盘在排除先兆子痫（10.3 vs. 1.6%，p=0.049）和弥漫性绒毛管病（62.2 vs. 32.5%，p< 0.001）的女性时，蜕膜血管病变发生率较高，但绒毛不成熟率较低（10.8% vs. 90.5%，p<0.001）。 p=0.007) 完全调整后。胎盘血管病变异常因母亲糖尿病类型而异，可能反映潜在的病理生理机制。有必要对胎盘病理学和代谢紊乱进行进一步研究。
During a pregnancy complicated by diabetes, the placenta undergoes a number of functional and structural pathologic changes. However, differences across studies may reflect pathophysiologic differences of diabetes types under investigation. We examined placental pathology from women ages 18–40 years with self-identified race/ethnicity; singleton, live births; and type 1 (T1DM; n=36), type 2 (T2DM; n=37), or gestational diabetes mellitus (GDM; n=126). Clinical data were abstracted from medical records. Placental diagnoses were independently re-reviewed by a perinatal pathologist. Multivariable analyses adjusting for race, gestational weight gain, gestational age, and systolic blood pressure were conducted. Women with T1DM compared with either T2DM or GDM had higher gestational weight gain (mean ± SD, T1DM vs. T2DM: 28.5 ± 12.4 vs. 20.5 ± 13.4 kg, p=0.03; or GDM: 21.3 ± 12.7 kg, p=0.009) and insulin use (T2DM: 100.0% vs. 85.3%, p=0.02; or GDM: 4.0%, p<0.001). Women with T1DM compared with either T2DM or GDM also had a similarly lower prevalence of placental infarcts in univariate analyses; however, these findings did not remain significant after multivariable adjustment. Also, placentas from women with T2DM compared to GDM had higher rates of decidual vasculopathy when excluding women with preeclampsia (10.3 vs. 1.6%, p=0.049) and diffuse chorangiosis (62.2 vs. 32.5%, p< 0.001) but a lower rate of villous immaturity (10.8 vs. 90.5%, p=0.007) after full adjustment. Placental vasculopathic abnormalities differ by maternal diabetes type, potentially reflecting underlying pathophysiologic mechanisms. Further research on placental pathology and metabolic derangements is warranted.