Placental structural abnormalities in gestational diabetes and when they develop: A scoping review

Abstract

Gestational diabetes mellitus (GDM) is defined as diabetes with onset or first recognition during gestation. It is a common complication of pregnancy that has become more prevalent over the past few decades. Abnormalities in fetal growth, including increased incidence of both large and small for gestational age babies, suggest placental dysfunction. The major goal of this scoping review is to determine what is known about abnormalities in placentas delivered from GDM pregnancies, and how early in gestation these abnormalities arise. A secondary goal is to review to what extent other selected factors, in particular obesity, have been found to influence or modify the reported effects of GDM on placental development, and whether these are considered in the study of GDM placentas. PubMed and Scopus databases were searched using the key terms: "gestational diabetes AND (woman OR human) AND placenta AND (ultrasound OR ultrastructure OR imaging OR histology OR pathology). Studies of gross morphology and histoarchitecture in placentas delivered from GDM pregnancies consistently report increased placental size, villous immaturity and a range of vascular lesions when compared to uncomplicated pregnancies. In contrast, a small number of ultrasound studies have examined placental development in GDM pregnancies in the second, and especially, the first trimester. Relatively few studies have analyzed interactions with maternal BMI, but these do suggest that it may play a role in placental abnormalities. Further examination of placental development early in pregnancy is needed to understand when it becomes disrupted in GDM, as a first step to identifying the underlying causes.

Keywords: Gestational diabetes; Placental pathology; Placental ultrasound.

Figure 1:

Scoping review strategy

Figure 2:

Summary of histopathological anomolies in GDM placentas (A) Illustrated cross-section of placental villous tissue at term. (B) Abnormalities frequently observed in GDM placentas include villous immaturity (reduced terminal villous surface area, reduced syctyiovascular membranes, increased cytotrophoblast), vascular lesions like intervillous fibrin deposition (IFD), and excess syncytial knots. SV = stem villus, IV= intermediate villus, TV=terminal villus, CTB=cytotrophoblast, STB=syncytiotrophoblast. Inset: mitochondrial damage is also a feature of GDM placental trophoblast cells. Illustration created with BioRender.