The impact of maternal diabetes on birth to placental weight ratio and umbilical cord oxygen values with implications for fetal-placental development.

Autor: Choo S; Department of Obstetrics and Gynecology, Western University, London, Canada., de Vrijer B; Department of Obstetrics and Gynecology, Western University, London, Canada; Children's Health Research Institute, Western University, London, Canada., Regnault TRH; Department of Obstetrics and Gynecology, Western University, London, Canada; Department of Physiology and Pharmacology, Western University, London, Canada; Children's Health Research Institute, Western University, London, Canada., Brown HK; Interdisciplinary Centre for Health and Society, University of Toronto, Toronto, Canada., Stitt L; Department of Obstetrics and Gynecology, Western University, London, Canada., Richardson BS; Department of Obstetrics and Gynecology, Western University, London, Canada; Department of Physiology and Pharmacology, Western University, London, Canada; Department of Pediatrics, Western University, London, Canada; Children's Health Research Institute, Western University, London, Canada. Electronic address: brichar1@uwo.ca.
Jazyk: angličtina
Zdroj: Placenta [Placenta] 2023 May; Vol. 136, pp. 18-24. Date of Electronic Publication: 2023 Feb 24.
DOI: 10.1016/j.placenta.2023.02.008
Abstrakt: Introduction: We determined the impact of gestational diabetes (GDM) and pre-existing diabetes (DM) on birth/placental weight and cord oxygen values with implications for placental efficiency and fetal-placental growth and development.
Methods: A hospital database was used to obtain birth/placental weight, cord PO 2 and other information on patients delivering between Jan 1, 1990 and Jun 15, 2011 with GA >34 weeks (N = 69,854). Oxygen saturation was calculated from the cord PO 2 and pH data, while fetal O 2 extraction was calculated from the oxygen saturation data. The effect of diabetic status on birth/placental weight and cord oxygen values was examined adjusting for covariates.
Results: Birth/placental weights were stepwise decreased in GDM and DM compared to non-diabetics with placentas disproportionally larger indicating decreasing placental efficiency. Umbilical vein oxygen was marginally increased in GDM but decreased in DM attributed to the previously reported hyper-vascularization in diabetic placentas with absorbing surface area of capillaries initially increased, but then constrained by increasing distance from maternal blood within the intervillous space. Umbilical artery oxygen was unchanged in GDM and DM, with fetal O 2 extraction decreased in DM indicating that fetal O 2 delivery must be increased relative to O 2 consumption and likely due to increased umbilical blood flow.
Discussion: Increased villous density/hyper-vascularization in GDM and DM with placentas disproportionately larger and umbilical blood flow increased, are postulated to normalize umbilical artery oxygen despite increased birth weights and growth-related O 2 consumption. These findings have implications for mechanisms signaling fetal-placental growth and development in diabetic pregnancies and differ from that reported with maternal obesity.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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