Medizinische Universität Graz - Research portal
Selected Publication:
Yoshida, K.
Gestational Diabetes effects on placental development and fetal outcome
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2018. pp. 95
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- Advisor:
- Desoye Gernot
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- Abstract:
- Gestational diabetes mellitus (GDM) has become a hot topic over the last few decades regarding its influence on the maternal metabolism and fetal outcome. In this thesis, a substantial focus is put on its effects on the placental vascular development and correlations with fetal outcome. The diabetic metabolic situation causes hyperglycemia, hypoglycemia, hyperinsulimenia and oxidative stress in the mother and the fetus. These alterations trigger a sequence of changes in the development of the vessels in the placenta. Consequently, the fetus is affected by this lack of supply of necessary substances or overstimulated by pathological factors with significant risk for abnormal development. This thesis focuses on the GDM associated factors on the alteration of functional and structural placental development in terms of vascular development. Maternal and fetal adaptations are taken into account as causes for pathologies and diverse outcomes. This paper also addresses GDM effects on proangiogenic factors and endothelial function, which are crucial in understanding the changes in the placenta and fetus in this disease. The research for this thesis was conducted using the international online database PubMed and the inventory of the Library of the Medical University of Graz. The information used originates from 300 sources, such as books, reviews and studies published in the years 1967-2018. Both the fetus and placental circulation provide a range of growth factors necessary for angiogenesis and vascular growth. The major regulators of angiogenesis are the VEGF system, the FGF system, angiopoietin system, EG-VEGF/PROKR system, EPO, IL6 and TNFA, Insulin and IGFs, Leptin and adinopoectin. All of these are sensitive to hypoxia, which is one of the key changes from hyperglyecemia and hyperinsulinemia caused by GDM. Diabetic metabolic changes are associated with enlarged and distinct hypervascularization of the placenta. Oxidative stress, inflammation, changes in the transport of nutrients, and endothelial dysfunction under the influence of adenosine, transporters, and receptors in the GDM placenta are responsible for the adaptive responses in the mother, the fetus and the placental vasculature that correlate with GDM associated pathologies and fetal malformation.