Endocrine Abstracts

Objective: The present study was designed to investigate the impact of insulin treatment on placental maternal and fetal vascular circulation in obese and non-obese women with gestational diabetes mellitus (GDM).

Design and methods: One hundred and ninety two women with GDM who gave birth and underwent a placental histopathological examination at Wolfson Medical Center were included in the study: 123 women who were treated with diet (Group 1) and 69 women who were treated with diet plus insulin (Group 2). Additionally, each group was divided into two subgroups according to pre-pregnancy BMI: non-obese (A) and obese (B).

Results: Maternal vascular malperfusion lesions did not differ significantly between groups. Vascular lesions related to fetal malperfusion were significantly lower in GDM women treated by insulin and diet compared to women with diet alone (P=0.027). Among fetal malperfusion lesions, villous changes consistent with fetal thrombo-occlusive disease (FTOD) increased from Group 1 to Group 4 in a continuous fashion and were higher in diet treated obese women than in other study groups (0, 3.5, 13 and 26.5%, P=0.009). In the logistic regression analysis, insulin treatment was significantly associated with a decreased rate of villous changes consistent with FTOD (OR 0.97, 95% CI 0.12–0.80, P=0.03).

Conclusion: Combination of obesity and GDM increased rate of villous changes consistent with FTOD and prevalence of gestational hypertension in both treatment groups. Insulin plus diet treatment was associated with improved fetal placental vascular circulation. Prevention of obesity throughout women’s childbearing age may translate to improved placental circulation and better pregnancy outcomes.