Histomorphometry of the human placenta in class C diabetes mellitus

doi:10.1016/S0143-4004(85)80034-5

Placenta

Volume 6, Issue 1, January–February 1985, Pages 69-81

https://doi.org/10.1016/S0143-4004(85)80034-5 Get rights and content

Summary

Placentae from Class C diabetic mothers were compared by histomorphometric analyses with a group of normal placentae. The placentae of the diabetics were divided in two groups based on the growth characteristics and neonatal outcome of the infants at birth. This study has demonstrated that the placentae of both groups were somewhat heavier than the controls due to a parallel increase in parenchymal and non-parenchymal tissues. The placentae were also shown to be characterized by a relative increase in the surface areas of exchange between mother and fetus, in terms of peripheral villous and capillary surface areas and intervillous space volume. Consequently, the results of this study suggest that, in Class C diabetics, placental morphology and placental function are probably not more adversely affected than in other less severe forms of the disease during pregnancy. Furthermore, the findings in this investigation support the hypothesis that the placental changes, and the perinatal morbidity associated with this condition, are probably the results of hormonal and metabolic abnormalities present in the mother and the fetus.

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Cited by (46)

Diabetes Mellitus, Obesity, and the Placenta
2020, Obstetrics and Gynecology Clinics of North America
Postpartum placental CT angiography in normal pregnancies and in those complicated by diabetes mellitus
2018, Placenta
Citation Excerpt :
Strength of our study was the ability to demonstrate the entire fetoplacental vasculature except for the smallest vessels (capillaries). The majority of previous studies is based on placental biopsies [3,9,14,15], which might not reflect the placental pathology of the entire placenta. It is well known that the normal placenta has a heterogeneous vessel maturation [42], and also the diabetic placenta is known to have focal pathology such as dysmature villous structures [25].
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).
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.
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).
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.
Impact of maternal diabetes type 1 on proliferative potential, differentiation and apoptotic activity in villous capillaries of term placenta
2016, Placenta
Citation Excerpt :
Maternal diabetes mellitus manifests itselfs also in altered placental capillary development. Enhanced total capillary volume, length and surface area [4–8], and enhanced capillary branching in both gestational and type 1 diabetes [9,10] suggest more active angiogenesis or, on the other hand, less active apoptosis. The autoradiographic studies on cell proliferation brought varied results.
Maternal diabetes mellitus changes morphology and impairs function of placental capillaries. Here, quantitative parameters characterizing cell proliferation using detection of Ki67, differentiation reflected by nestin expression and apoptosis in placental capillary bed with active caspase 3 as a marker were compared in normal term placentas and placentas from pregnancies complicated by Type 1 maternal diabetes mellitus.
Specimens of sixteen diabetic placentas and eight control placentas were collected by systematic uniform random sampling. Immunohistochemical detections of Ki67, nestin, and active caspase 3 were performed in histological sections of five haphazardly chosen blocks per placenta. Twenty fields of view per section, i.e. one hundred fields of view per placenta, were used for analysis of proliferation as well as of apoptosis, and in approximately 70 capillary cross-sections per placenta the nestin-positive segments of their circumference were measured.
The percentage of Ki67-positive cells counted in the capillary wall was significantly lower in diabetic group. The counts of Ki67-labelled nuclei per villous area unit were significantly lower in cytotrophoblast and capillary wall of terminal villi in diabetic placenta. The proportion of nestin-labeled segments of capillary circumference was significantly higher in placentas of diabetic group. No differences in the numbers of apoptotic cells were found between studied groups.
The results show that the term placenta in Type 1 diabetes has lower potential to enlarge the surface area of structures involved in maternofetal transport, and that the villous capillary bed displays delayed differentiation. Those factors may participate in decreased ability of diabetic placenta to comply with fetal requirements in the final stage of pregnancy.
A systematic review of placental pathology in maternal diabetes mellitus
2015, Placenta
Citation Excerpt :
Immature intermediate villi also contain reticular stroma [13]. Moreover, several studies compared the parenchymal tissue in diabetic women compared to healthy controls [7,9,11,38]. In women with White Class B, White Class C, and White Class A diabetes, Teasdale [9,11,38] found a significant increase in parenchymal tissue, defined as the intervillous space, the trophoblast layer, and fetal capillaries of both the peripheral and stem villi.
During a pregnancy complicated by diabetes, the human placenta undergoes a number of functional and structural pathologic changes, such as increased placental weight and increased incidence of placental lesions including villous maturational defects and fibrinoid necrosis. The pathologic findings reported have differed among studies, potentially reflecting differences in type of diabetes, study methodology, or glycemic control of study participants. Alternatively, these discrepancies may represent different biologic adaptations to distinct metabolic diseases.
We conducted a comprehensive review of English language citations in Pubmed and Embase using the keywords “diabetes”, “placenta”, AND “pathology”. Abstracts were reviewed for relevance then full-text articles were reviewed in order to extract a comprehensive summary of current pathological findings associated with pregestational and gestational diabetes mellitus, as well as an understanding of the impact of glycemic control on placental pathology.
Placental abnormalities most consistently associated with maternal diabetes are an increased incidence of villous immaturity, increased measures of angiogenesis, and increased placental weight.
The literature suggests that, despite similarities in placental abnormalities, differences in placental pathology may reflect differences in pathophysiology among different types of diabetes. Consequently, standardization of terminology used to define placental lesions is warranted. Moreover, further research is needed to investigate the impact of pathophysiology, glycemic control and clinical factors, such as infant sex, weight and race, on placental structure and function.
The branching pattern of villous capillaries and structural changes of placental terminal villi in type 1 diabetes mellitus
2012, Placenta
Maternal diabetes is associated with changes of the placental structure. These changes include great variability of vascularity manifested by strikingly hypovascular as well as hypervascular terminal villi. In this paper, normal placental terminal villi and pathological villi of type 1 diabetic placentas were compared concerning the structure of villous stroma, spatial arrangement of villous capillary bed and quantitative assessment of capillary branching pattern.
Formalin fixed and paraffin embedded specimens of 14 normal and 17 Type 1 diabetic term placentas were used for picrosirius staining, vimentin and desmin immunohistochemistry and confocal microscopy. 3D models of villi and villous capillaries were constructed from stacks of confocal optical sections.
Hypervascular as well as hypovascular villi of diabetic placenta displayed changed structure of villous stroma, i.e. the collagen envelope around capillaries looked thinner and the network of collagen fibers seemed less dense. The desmin immunocytochemistry has shown that stromal cells of hypervascular as well as hypovascular villi appeared nearly or completely void of desmin filaments. In comparison with normal villi, capillaries of hypovascular villi had a smaller diameter and displayed a markedly wavy course whereas in hypervascular villi numerous capillaries occurred in reduced stroma and often had a large diameter. The quantitative assessment of capillary branching has shown that villous capillaries are more branched in diabetic placentas.
It is concluded that type 1 maternal diabetes enhances the surface area of the capillary wall by elongation, enlargement of diameter and higher branching of villous capillaries and disrupts the stromal structure of terminal villi.
Stereology of the placenta in type 1 and type 2 diabetes
2011, Placenta
To assess by stereology the placental structure in type 1 (T1DM) and type 2 (T2DM) diabetic pregnancies compared to normal non-diabetic (ND) controls.
Prospective case control study. Placentae were sampled in a systematic random fashion. Stereological analysis was performed using a computerised stereology programme (Image Pro 6.2, Media Cybernetics, Inc, Silver Spring MD, USA). Participants were matched for gender of infant and mode of delivery.
Volume, length and surface area of placental components; clinical outcome.
Ten ND, eight T2DM and ten T1DM women consented to the study. There was no difference between the groups regarding maternal age, neonatal birth weight, or placental weight. On stereological examination, terminal villous volume was significantly increased in both diabetic groups compared to ND controls. Capillary volume and length was increased in T1DM pregnancies compared to ND and T2DM. Capillary length was increased in both diabetic groups compared to ND. When all diabetic groups were compared based on severity of glycaemia those with poor glycaemic control (HbA1c>7%) had higher placental capillary volume than those with good glycaemic control.
This study demonstrates an association between maternal diabetes and increased terminal villous volume. Additionally capillary volume and length is increased in the placentae of normally grown infants of T1DM diabetic mothers compared to non-diabetic controls. Maternal glycaemia appears to influence capillary, but not stromal, development. This suggests that factors other than glycaemia have a role in placental development in pre-gestational diabetes.

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Histomorphometry of the human placenta in class C diabetes mellitus

Summary

American Journal of Obstetrics and Gynecology

Placenta

American Journal of Obstetrics and Gynecology

Americal Journal of Obstetrics and Gynecology

Journal of Pediatrics

American Journal of Obstetrics and Gynecology

American Journal of Obstetrics and Gynecology

American Journal of Obstetrics and Gynecology

American Journal of Obstetrics and Gynecology

Placenta

Journal of Pediatrics

Placenta

American Journal of Obstetrics and Gynecology

Ultrastructure of the villi and fetal capillaries of the placentas delivered by non-smoking diabetic women (White group D)

Acta Pathologica et Microbiologica Scandinavica

Effects of sustained insulin infusion upon glucose uptake and oxygenation of the ovine fetus

Pediatric Research

Beitrag zur Morphologie der myometrialen und dezidualen arterien bei normalen Schwangerschaften, EPH-Gestosen und mütterlichem Diabetes mellitus

Pathologia et Microbiologia

The epithelial and capillary basal laminae of the placenta in maternal diabetes mellitus

Laboratory Investigation

Pathology of the placenta in maternal diabetes mellitus

Obstetrics and Gynecology