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