Does gestational diabetes mellitus (GDM) affect the placenta?
Such adverse conditions exist in pregnancies complicated by gestational diabetes mellitus (GDM), and have been associated with alterations in placental anatomy and physiology.
How does diabetes affect pregnancy?
While the pancreas normally is able to overcome insulin resistance, sometimes it fails and the result is gestational diabetes or a worsening of pregestational diabetes. Diabetes can affect pregnancy in numerous ways depending on the type of diabetes you have and to what degree. Some complications include:
How does the placenta affect the fetal development?
By its location between maternal and fetal bloodstreams the human placenta not only handles the materno-fetal transport of nutrients and gases, but may also be exposed to intrauterine conditions adversely affecting placental and fetal development.
How does insulin sensitivity change during pregnancy?
In pregnancy insulin sensitivity decreases, thereby pregnant females are at greater risk to have deranged blood glucose levels and subsequently some of them develop gestational diabetes mellitus (GDM).
Does gestational diabetes cause placenta deteriorate?
Placental structure and function can be changed as a result of maternal diabetes. The nature and extent of these changes depend on the type of diabetes and on the gestational period.
How do I know if my placenta is failing gestational diabetes?
A sudden drop in blood sugar levels – levels dropping much lower than usual for you to very low levels (2.0's – 3.0's mmol/L) consistently can be a sign that there are issues with the function of the placenta. It is best to consult a medical professional if you see a drop in levels like this.
What causes placenta to deteriorate?
Placental insufficiency can occur if you smoke or take some kinds of illegal drugs while you're pregnant. Medical conditions such as diabetes, pre-eclampsia and blood clotting conditions also increase your risk.
How does diabetes affect a baby in the womb?
Diabetes during pregnancy—including type 1, type 2, or gestational diabetes—can negatively affect the health of women and their babies. For women with type 1 or type 2 diabetes, high blood sugar around the time of conception increases babies' risk of birth defects, stillbirth, and preterm birth.
What are signs of placenta problems?
Signs and symptoms of placental abruption include:Vaginal bleeding, although there might not be any.Abdominal pain.Back pain.Uterine tenderness or rigidity.Uterine contractions, often coming one right after another.
How do I keep my placenta healthy?
The recommended intake of iron almost doubles during pregnancy. As such, iron rich foods such as spinach, broccoli and kale are crucial during pregnancy. Low levels of iron could result in a deficiency and hinder the transfer of oxygen and nutrients to the placenta.
What can damage placenta?
Certain placental problems are more common in women who smoke or use cocaine during pregnancy. Abdominal trauma. Trauma to your abdomen — such as from a fall, auto accident or other type of blow — increases the risk of the placenta prematurely separating from the uterus (placenta abruption).
What does insulin do to the placenta?
Although insulin does not cross the placenta, glucose and other nutrients do. So extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the baby's pancreas to make extra insulin to get rid of the blood glucose.
When do placenta problems start?
About 1 in 100 pregnant people (1 percent) have placental abruption. It usually happens in the third trimester but it can happen any time after 20 weeks of pregnancy. Mild cases may cause few problems. An abruption is mild if only a very small part of the placenta separates from the uterus wall.
What happens if your diabetic and pregnant?
Poor control of diabetes during pregnancy increases the chances for birth defects and other problems for the baby. It can also cause serious complications for the woman. Proper health care before and during pregnancy can help prevent birth defects and other health problems.
What are the symptoms of high sugar during pregnancy?
Some women may develop symptoms if their blood sugar levels gets too high (hyperglycaemia), such as:increased thirst.needing to pee more often than usual.a dry mouth.tiredness.
What is the newborn of a diabetic mother at risk to develop?
The infant of a diabetic mother is at risk of transient hyperinsulinism, which prevents at birth the normal activation of metabolic pathways producing glucose and ketone bodies, and causes increased glucose consumption by tissues[17].
Does gestational diabetes get worse towards the end of pregnancy?
Between 32 – 36 weeks are what we know to be the toughest time for gestational diabetes. It's at around this point that we typically see insulin resistance worsen.
How does gestational diabetes cause fetal death?
Stillbirth (fetal death). Stillbirth is more likely in pregnant women with diabetes. The baby may grow slowly in the uterus due to poor circulation or other conditions, such as high blood pressure or damaged small blood vessels.
Does gestational diabetes get better towards the end of pregnancy?
For most women with gestational diabetes, the diabetes goes away soon after delivery. When it does not go away, the diabetes is called type 2 diabetes. Even if the diabetes does go away after the baby is born, half of all women who had gestational diabetes develop type 2 diabetes later.
Why is there an increased risk of stillbirth with gestational diabetes?
Diabetes can also stop babies from growing normally – they are born either too small (fetal growth restriction (FGR)) or too large (macrosomia), both of which dramatically increase the risk of stillbirths.
Background to research
At the beginning of pregnancy, the embryo embeds into the wall of the womb. The womb then sends instructions to the embryo that affect the development of the placenta, which is responsible for transferring nutrients to the baby.
Research aims
Professor Westwood wants to find out if the blood sugar level of the mother at the beginning of pregnancy sets the course for the baby’s health throughout life.
Potential benefit to people with diabetes
Having a larger baby increases the risk of complications for both mother and baby during birth, as well as health problems for the child later in life. This study will help fill the gap in our knowledge about how high blood sugar affects the way the placenta works during pregnancy.
What is gestational diabetes?
Gestational diabetes is a condition where the blood glucose level is increased during pregnancy, In addition, other diabetic symptoms may appear although the woman had not been previously diagnosed with diabetes.
How many times more likely are diabetic mothers to have birth defects?
Studies show that infants of diabetic mothers are two to six times more likely to have birth defects. Overall, major birth defects occur in five to ten perfect of infants born to insulin-dependent mothers. These birth defects can affect:
What Can I Expect During Delivery With Diabetes?
It’s normal for any expectant mother to be nervous leading up to delivery, especially for those who live with diabetes. While labor is undoubtedly a stressful time, your doctor will help you throughout the process.
What happens to the pancreas during pregnancy?
Through pregnancy as the placenta grows, additional hormones are produced which increases insulin resistance. While the pancreas normally is able to overcome insulin resistance, sometimes it fails and the result is gestational diabetes or a worsening of pregestational diabetes.
Why are babies born with diabetes bigger than the average?
Babies born to women with diabetes tend to be larger because high levels of blood sugar cause the baby to get too much sugar in the placenta.
Why does blood sugar drop after birth?
Hospitals keep a close eye on babies born to mothers with diabetes following birth as their blood sugar can dip dangerously low . This occurs because the baby is used to your sugar and insulin levels. Once they are out of the womb, they can experience a significant drop. If this occurs, medical staff will give your baby glucose to balance their levels. In addition to glucose, their levels of calcium and magnesium can be off too, but both can be treated with medication.
What is Type 1 diabetes?
This is an autoimmune disorder where the body’s immune system attempts to destroy the insulin-producing cells in the pancreas.
What is the most powerful predictor of gestational diabetes?
The most powerful predictor was the placental maturity grade, the patients with decreased maturity grade having chances 52.6 times higher than those with an increased placental maturity grade to associate gestational diabetes.
Is placental damage a risk factor for diabetes?
Placental damage may be responsible for the fet al complications in pregnancies complicated by diabetes. We have analyzed the prevalence of gestational diabetes (GD) in a population of 109 pregnant women, the risk factors and the placental changes associated with gestational diabetes. Tests carried out were oral glucose tolerance test at 24-28 weeks of gestation, using the IADPSG (International Association of Diabetes and Pregnancy Study Groups) criteria for gestational diabetes, glycated hemoglobin, fasting insulin, total cholesterol, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL)-cholesterol, triglycerides, two-dimensional (2D) ultrasound and, also, there were analyzed macro and microscopic placental fragments from pregnant women with÷without GD. It has been recorded the weight of placenta at birth and there were analyzed the possible pathological changes. The prevalence of GD was 11.9%. We have applied the direct logistic regression to determine the impact of some factors over the probability of association with gestational diabetes. The most powerful predictor was the placental maturity grade, the patients with decreased maturity grade having chances 52.6 times higher than those with an increased placental maturity grade to associate gestational diabetes. Sizes of placentas in patients with gestational diabetes mellitus were significantly increased than in patients without this diagnosis (p=0.012) from week 24-28. Pathological changes were discovered in six of the 13 placentas of women with gestational diabetes mellitus, independent of the level of glycated hemoglobin (p=0.72). The level of hyperglycemia is only partially associated with the presence of placental changes, which may be caused by other maternal factors.
What is the role of the placenta in maternal and fetal blood circulation?
The placenta acts as a natural selective barrier between maternal and fetal blood circulations.
Is the placenta sensitive to hyperglycemic conditions?
Placenta is sensitive to the hyperglycemic milieu and responses with adaptive changes of the structure and function. Alteration of the placental development and subsequent vascular dysfunction are presented in 6 out of 7 women with all ranges of diabetic severity.
Is GDM a maternal or neonatal condition?
Nowadays, the continuous rise of maternal obesity is followed by increased gestational diabetes mellitus incidence. GDM is associated with adverse fetal and neonatal outcome that often presents with macrosomia, birth trauma, neonatal hypoglycemia, and respiratory distress syndrome. Inclusion of GDM into 'the great obstetrical syndromes' emphasizes ...
Does GDM affect placental function?
Generally, if impaired glucose metabolism is diagnosed in the early pregnancy, mainly structural dysfunctions are observed. GDM that is detected in late gestation affects placental function to a greater extent. Moreover many studies suggest ...
How does gestational diabetes affect the placenta?
Gestational diabetes produces changes in placenta secondary to change in the milieu of the mother and the fetus. To compensate the hyperglycemic blood from the mother, there is islets cell hypertrophy and beta cell hyperplasia of fetal pancreas with the release of excessive amounts of insulin in the fetal body. This results in a hyper-insulinemic state in the fetus with the up regulation of many genes expression, inflammatory mediators and leptin in placental tissues. This whole process probably produces excessive growth and increase in placental weight. Increased placental volume compensates the need of growing babies to an extent and after that hypoxic state generates leading to adverse fetal and maternal outcomes even unexplained termed intrauterine deaths. Placental tissues are liable to change with maternal metabolic issues. Our results have shown increase in placental weight in both the groups but a significant increase in placental weight is observed when glycemic control was done with diet control plus injectable insulin as compared to diabetics controlled on diet and exercise only. This indicates that exogenous insulin has exerted more effects on the placenta than the other group. According to Boyd, placental parenchymal tissues of insulin treated patients were much heavier in volume.15Mayhew and Chowdhury worked on insulin treated diabetic pregnancies and found that GDM placental weights were significantly increased. The results of both these studies are in favor of our findings.16,17Placental cord length, membrane completeness, placental shape, consistency, cord insertion, cord color and gross pathologies showed non-significant results between the two groups but with more propensities in the insulin treated group. Verma has discussed that on major gross examination of placentae, there were non-significant differences which is just similar to our results.18It has been documented in literature that acute pulsatile rise and fall in the mother’s blood sugars as after food intake (hyperglycemia) and insulin treatment (hypoglycemia) might be unnoticed and account for increased fetal release of endogenous insulin resulting in big placenta and babies as compared to females on diet restricted therapy which is again in favor of our study.19
Why is the cord thicker in diabetic placentae?
The relevance of these factors with the diabetic environment is yet to be evaluated but the probable reason of excessive growth of the cord tissue which makes it thicker is the effect of fetal insulin. Although non-significant statistically but more fibronoid necrosis was seen in insulin treated placentae. As per literature this type of necrosis is indication of placental compromise and therefore decreased supply of nutrients and oxygen to the growing fetus leading to hypoxia.20
Why are GDM babies heavier than diet control?
Persson stated that babies of GDM mothers on insulin treatment and on diet control are similar in the weight.23But a recent study by Wong has proven the fact that the babies of insulin treated GDM were heavier than diet control GDM mothers, so more GDM mothers on insulin treatment delivered through cesarean section due to fetal overgrowth and heavy term babies24and is coinciding with our findings. We observed more intrauterine deaths in insulin treated group and the probable reason is the excessive growth of fetus which increases the oxygen demands. Placenta tries to compensate this to an extent but when the baby is grown enough and is near term, it cannot fulfill the requirements of fetus resulting in unexplained term intrauterine death in these patients.25Our findings suggest that exogenous insulin probably improves the glycemic values but is unable to control the related problems completely as is evident from statistics. This point towards the presence of unknown areas in GDM pathology and need of alternative pharmacotherapy for GDM patients.
Why are babies heavier in GDM?
When fetal outcomes were compared , it was seen that babies were much heavier in patients in insulin treated GDM group as compared to diet controlled group. Odar has stated that increased fetal weights leads to bad maternal and fetal outcomes, which is again similar to our study and the reason behind is the hyper-insulinemic state of the fetus affecting both the placental and fetal growth.21Jansson described that probably excessive fetal growth is the result of increase in substrate availability which stimulates fetal insulin secretion and fetal growth. However, despite of strict glycemic control in modern clinical management of the pregnant woman with significant hyperglycemia, fetal overgrowth remains an important clinical problem. Recent studies have provided enough evidence for increased delivery of amino acids to the fetus in gestational diabetes (GDM), even when metabolic control is strict. So might be for this reason even when truly normal maternal substrate levels are achieved in diabetic pregnancies, the defect lies in altered placental nutrient transport and metabolism.22
How to control blood glucose levels in the mother?
Blood glucose levels in the mother can be controlled by nutritional therapy (diet control) and exercise but in uncontrolled cases, where target glycemic levels could not be achieved medication are also required. Subcutaneous insulin is the traditional therapy and gold standard under such circumstances.9Even with this pharmacotherapy, fetal and maternal morbidity and mortality are well documented in the literature.10Morphological study of placenta which occupies central position between the mother and fetus might be helpful in elucidating these adverse fetal and maternal outcomes in gestational diabetes. With this background present study was designed to observe the effect of exogenous insulin on the gross morphology of placenta, fetal and maternal outcomes in gestational diabetics in our setting.
Does insulin affect placental outcomes?
Insulin has produced significant effects on the placental, fetal and maternal outcomes in patients having gestational diabetes mellitus in comparison to GDMs controlled on diet and exercise.
