Postpartum placental CT angiography in normal pregnancies and in those complicated by diabetes mellitus

Mette Østergaard Thunbo; Marianne Sinding; Pauline Bogaard; Anne Sofie Korsager; Jens Brøndum Frøkjær; Lasse Riis Østergaard; Astrid Petersen; Anne Sørensen

doi:10.1016/j.placenta.2018.06.309

Postpartum placental CT angiography in normal pregnancies and in those complicated by diabetes mellitus

Mette Østergaard Thunbo, Marianne Sinding, Pauline Bogaard, Anne Sofie Korsager, Jens Brøndum Frøkjær, Lasse Riis Østergaard, Astrid Petersen, Anne Sørensen^*

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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Abstract

Introduction: 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). Methods: 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. Results: 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). Discussion: 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.

Original language	English
Journal	Placenta
Volume	69
Pages (from-to)	20-25
Number of pages	6
ISSN	0143-4004
DOIs	https://doi.org/10.1016/j.placenta.2018.06.309
Publication status	Published - 2018
Externally published	Yes

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10.1016/j.placenta.2018.06.309

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@article{97f3479ff53a42998230e1ba71a84221,

title = "Postpartum placental CT angiography in normal pregnancies and in those complicated by diabetes mellitus",

abstract = "Introduction: 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). Methods: 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. Results: 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). Discussion: 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.",

author = "Thunbo, {Mette {\O}stergaard} and Marianne Sinding and Pauline Bogaard and Korsager, {Anne Sofie} and Fr{\o}kj{\ae}r, {Jens Br{\o}ndum} and {\O}stergaard, {Lasse Riis} and Astrid Petersen and Anne S{\o}rensen",

year = "2018",

doi = "10.1016/j.placenta.2018.06.309",

language = "English",

volume = "69",

pages = "20--25",

journal = "Placenta",

issn = "0143-4004",

publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Postpartum placental CT angiography in normal pregnancies and in those complicated by diabetes mellitus

AU - Thunbo, Mette Østergaard

AU - Sinding, Marianne

AU - Bogaard, Pauline

AU - Korsager, Anne Sofie

AU - Frøkjær, Jens Brøndum

AU - Østergaard, Lasse Riis

AU - Petersen, Astrid

AU - Sørensen, Anne

PY - 2018

Y1 - 2018

N2 - Introduction: 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). Methods: 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. Results: 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). Discussion: 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.

AB - Introduction: 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). Methods: 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. Results: 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). Discussion: 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.

U2 - 10.1016/j.placenta.2018.06.309

DO - 10.1016/j.placenta.2018.06.309

M3 - Journal article

AN - SCOPUS:85049795158

SN - 0143-4004

VL - 69

SP - 20

EP - 25

JO - Placenta

JF - Placenta

ER -

Postpartum placental CT angiography in normal pregnancies and in those complicated by diabetes mellitus

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