Comparative characteristics of the fetoplacental complex in women with type 1 diabetes and in pregnant women with gestational diabetes


  • A.P. Dnistryanska National Pirogov Memorial Medical University, Vinnytsya, Ukraine
  • O.S. Musienko National Pirogov Memorial Medical University, Vinnytsya, Ukraine
  • L.V. Yaremchuk National Pirogov Memorial Medical University, Vinnytsya, Ukraine
Keywords: fetal biophysical profile, gestational diabetes, Doppler ultrasound, extragenital pathology, ultrasound, resistance index, fetoplacental complex, diabetes mellitus.

Abstract

Annotation. In the structure of causes of maternal mortality, extragenital pathology accounts for 25%. Among them, endocrine pathology is 6%, diabetes accounts for 31.9%. 1% of women of childbearing age suffer from type 1 diabetes, and 2–17% has gestational diabetes (GD). The aim is to compare the condition of the fetoplacental complex in the third trimester of pregnancy in 9 pregnant women with type 1 diabetes (group 1) and in 12 women with GD (group 2) who were observed at “Vinnitsa City Clinical Hospital and child” for 2016–2019. The control group included 10 patients with physiological pregnancy. Women with diabetes had a history of gynecological diseases: colpitis (8 patients (88.8%)), cervical erosion (2 (22.2%)), chronic adnexitis (5 (55.5%)). Among the complications of previous pregnancies in the group of patients with diabetes mellitus (5 births) were unauthorized miscarriages (1 (11.1%)), the risk of termination of pregnancy (5 (55%)). In women with a history of GD, colpitis was observed in 3 (24.9%), which is significantly less than in women with type 1 diabetes. There were 2 pregnant women with GD: preterm births (16.6%). Among the complications of pregnancy in 1 patient was the threat of abortion in previous cases. Changes in the indexes of hemodynamics of the uterine-placental complex were evaluated on the basis of cardiotocography, ultrasound on ultrasound machine “Logic-5” with 2D measurement, Doppler, evaluation of the biophysical profile of the fetus (BPF). Statistical data processing was performed by calculating Student coefficients (+) using the Microsoft Excel program. It was established that in the 1st trimester of pregnancy, 5 (55.5%) women with type 1 diabetes were diagnosed with a threat of termination of pregnancy (TTP), and in the 1st (11.1%), they had a retroplacental hematoma. Two (22.2%) women with GD were diagnosed with TTF. In the 2nd trimester, 2 women with GD remained symptomatic of TTF. Six (66.7%) women with type 1 diabetes have symptoms of TTF. In the 1 pregnant woman developed pyelonephritis. Childbirth in 8 (88.8%) women with type 1 diabetes ended through natural birth canal, in 1 woman — a caesarean section. The weight of the child was 4435±2 g. In women with GD the weight of the child was 3756±12. In 7 (77.8%) patients, fetal weight exceeded 4000 g. BPF in the group of patients with diabetes was significantly different from the group with GD at 37–38 weeks of pregnancy. BPF in the 1st group — 7.6±0.2, in the 2nd group — 8.7±0.2, resistance index (RI): 1st group — 0.61±0.01, 2-ha group — 0.57±0.01, CO/K: in the 1st group — 3.2±0.1, in the 2nd group — 3.1±0.1. The correlation between the level of GD compensation and pathological changes in the fetoplacental complex has been established. The data obtained indicate that early screening of this pathology and appropriate compensation for carbohydrate metabolism in the presence of diabetes mellitus should be noted as one of the methods for the prevention of the development of complications in GD.

References

1. Avramenko, T. V., & Makarenko, M. V. (2016). Vplyv tsukrovoho diabetu na perebih vahitnosti, rozrodzhennia ta perynatalnu smertnist [The effect of diabetes on pregnancy, delivery and perinatal mortality]. Zdorove zhenshiny – Women's Health, 1, 79–83.

2. Ametov, A. S., & Soloveva, O. L. (2011). Serdechno-sosudistye oslozhneniya pri saharnom diabete: patogenez i puti korrekcii [Cardiovascular complications in diabetes mellitus: pathogenesis and correction methods]. Russkij medicinskij zhurnal – Russian Medical Journal, 27, 1694–1699.

3. Bondar, I. A., & Malysheva, A. S. (2013). Izmeneniya gemostaza u beremennyh s narusheniyami uglevodnogo obmena [Changes in hemostasis in pregnant women with impaired carbohydrate metabolism]. Saharnyj diabet – Diabetes mellitus, 2, 77–81.

4. Kocherova, V. V., & Sherbak, V. A. (2016). Somatotropnyj gormon i insulinopodobnye faktory rosta v patogeneze zaderzhki rosta ploda [Growth hormone and insulin-like growth factors in the pathogenesis of fetal growth retardation]. Tihookeanskij medicinskij zhurnal – Pacific Medical Journal, 1, 5–8.

5. Nazarova, S. I. (2012). Akusherskie i perinatalnye ishody pri gestacionnom saharnom diabete [Obstetric and perinatal outcomes in gestational diabetes]. Vestnik Avicenny – Bulletin of Avicenna, 1, 72–78.

6. Petruhin, V. A., & Burumkulova, F. F. (2014). Gestacionnyj saharnyj diabet [Gestational diabetes]. Arhiv akusherstva i ginekologii im. V.F. Snegiryova – Archive of Obstetrics and Gynecology. V.F. Snegireva, 1, 48–51. Vzyato s https://cyberleninka.ru/article/n/gestatsionnyy-saharnyy-diabet-3.

7. Saprina, T. V., Timohina, E. S., & Goncharevich, O. K. (2016). Sostoyanie enteropankreaticheskoj gormonalnoj sistemy pri gestacionnom saharnom diabete [The state of enteropancreatic hormonal system with gestational diabetes]. Saharnyj diabet – Diabetes mellitus, 2(19), 150–157. DOI: 10.14341/DM2004134-37.

9. Tarasenko, N. A. (2017). Saharnyj diabet: dejstvitelnost, prognozy, profilaktika [Diabetes mellitus: reality, prognosis, prevention]. Sovremennye problemy nauki i obrazovaniya – Modern problems of science and education, 6. ISSN 2070-7428. Vzyato s http://www.science-education.ru/ru/article/view?id=27144.

10. Tsytovskyi, M. N. (2017). Statystychnyi, klinichnyi ta morfolohichnyi aspekty vplyvu tsukrovoho diabetu na stan sertsevo-sudynnoi systemy [Statistical, clinical and morphological aspects of the effect of diabetes on the condition of the cardiovascular system]. Naukovyi visnyk Uzhhorodskoho universytetu. Seriia: “Medytsyna” – Uzhgorod University Scientific Bulletin. Series: “Medicine”, 1 (55), 168–177.

11. Agarwal, M. M. (2015). Gestational diabetes mellitus: an update on the current international diagnostic criteria. World Journal of Diabetes, 6 (6), 782–791. DOI: 10.4239/wjd.v6.i6.782.

12. Angueira, A. R., & Ludvik, A. E., & Reddy, T. E. (2015). New insights into gestational glucose metabolism: lessons learned from 21st century approaches. Diabetes, 64(2), 327–334. DOI:http://dx.doi.org/10.2337/db14-0877.

13. Kharroubi, A. T., & Darwish, H. M. (2015). Diabetes mellitus: The epidemic of the century. World J. Diabetes, 6 (6), 850–867. DOI: 10.4239/wjd.v6.i6.850.

14. Kuo, C. H., Chen, S. C., Fang, C. T., Nien, F. J., Wu, E. T., & Lin, S. Y. (2017). Screening gestational diabetes mellitus: The role of maternal age. PLoS ONE, 12(3), 165–169. DOI: http://dx.doi.org/10.1371/journal.pone.0173049.

15. Law, K. P., & Zhang, H. (2017). The pathogenesis and pathophysiology of gestational diabetes mellitus: Deductions from three-part longitudinal metabolomics study in China. Clinica Chimica Acta, 468, 60–70. DOI: 10.1016/j.cca.2017.02.008.

16. Mack, L. R., & Tomich, P. G. (2017). Gestational diabetes: diagnosis, classification, and clinical care. Obstetrics and Gynecology Clinics of North America, 44 (2), 207–217. DOI: 10.1016/j.ogc.2017.02.002.

17. Mirghani Dirar, A., & Doupis, J. (2017). Gestational diabetes from A to Z. World J. Diabetes, 8 (12), 489–506. DOI: http://dx.doi.org/10.4239/wjd.v8.i12.489.

18. Montandon, S. A., & Jornayvaz, F. R. (2017). Effects of Antidiabetic Drugs on Gut Microbiota. Genes (Basel), 8 (10), 250. DOI: 10.3390/genes8100250.

19. Morampudi, S., Balasubramanian G., Gowda, A., Zomorodi, B., & Patil, A. S. (2017). The challenges and recommendations for GDM care in India: a review. Frontiers in Endocrinology, 8 (56), 1–10. DOI: http://dx.doi.org/10.3389/ fendo.2017.00056.

20. Murphy R. (2015). Monogenic diabetes and pregnancy. Obstet Med, 8 (3), 114–120. DOI: http://dx.doi.org/10.1177/1753495X15590713.

21. Neal, В., Perkovic, V., & Matthews, D. R. (2017). Rationale, design and baseline characteristics of the CANagliflozin cardio-Vascular Assessment Study-Renal (CANVAS-R): a randomized, placebo- controlled trial. Diabetes Obes. Metab., 19, 387–393. DOI:10.1111/dom.12829.

22. Nguyen, C. L., & Pham, N. M., & Colin, W. B., & Duong D. V., & Lee A. H. (2018). Prevalence of Gestational diabetes mellitus in Eastern and Southeastern Asia: A systematic review and meta-Analysis. Diabetes Research, 1–10. DOI: http://dx.doi. org/10.1155/2018/6536974.

23. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes. (2018). Diabetes Сare, 41(1), 73–85. DOI: https://doi.org/10.2337/dc18-S008.

24. Wasalathanthri, S. (2015). Attenuating type 2 diabetes with postpartum interventions following gestational diabetes mellitus. World J. Diabetes, 6 (4), 648–53. DOI: 10.4239/wjd.v6.i4.648.

25. Wu, L., Cui, L., & Tam, W. H. (2016). Genetic variants associated with gestational diabetes mellitus: a meta-analysis and subgroup analysis. Sci. Rep., 6, 305–339. DOI: http://dx.doi.org/10.1038/srep30539.

26. Xu, T., He, Y., Dainelli, L., Yu, K., Detzel, P., & Silva-Zollezzi, I. (2017). Healthcare interventions for the prevention and control of gestational diabetes mellitus in China: a scoping review. BMC Pregnancy and Childbirth, 17(171). DOI: http://dx.doi.org/10.1186/s12884-017-1353-1.
Published
2019-12-30
How to Cite
Dnistryanska, A., Musienko, O., & Yaremchuk, L. (2019). Comparative characteristics of the fetoplacental complex in women with type 1 diabetes and in pregnant women with gestational diabetes. Reports of Vinnytsia National Medical University, 23(4), 652-658. https://doi.org/https://doi.org/10.31393/reports-vnmedical-2019-23(4)-16