Medizinische Universität Graz - Research portal
Selected Publication:
Spiekermann, S.
The Placenta in Women with Type 1 Diabetes Mellitus in Consideration of the Maternal HbA1c - A Literature Review
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2019. pp. 88
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- Authors Med Uni Graz:
- Advisor:
- Desoye Gernot
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- Abstract:
- Introduction: The human placenta is a transient organ aiming at an adequate and healthy fetal development. Its complex formation und function can be affected by maternal or fetal diseases. Pregnancies complicated by Maternal Type 1 Diabetes Mellitus (T1DM) are rarer than Type 2 Diabetes Mellitus (T2DM) or Gestational Diabetes Mellitus (GDM). Thus, investigations with respect to the placental alterations in T1DM have less emphasis in research. The present work analyses the impact of T1DM on the placenta in consideration of the maternal glycemic control, reflected by the glycated hemoglobin A (HbA1c). Methods: A comprehensive literature review was conducted. The online database ‘PUBMED’ was utilized for this research. Abstracts were reviewed for the sole investigation of T1DM placentas. Then results of full-text articles were reviewed and categorized after the maternal HbA1c value during pregnancy. An excellent glycemic control was defined as a HbA1c value ≤6%, a good control as 6.1-7% and a non-optimal glycemic control as values >7%. Secondary objectives were a representation of the development of placental weight for the time period between 1960 and 2017, the effect of the fetal sex on the placenta as well as the emergence of placental oxidative and nitrative stress. Results: The most frequent placental abnormalities in T1DM are an increased placental weight, villous immaturity and structural vascular changes, even in excellent controlled (≤6%) T1DM. Regarding the impact of the maternal HbA1c at a specific time period during pregnancy, studies show inconclusive results. Nevertheless, the average calculated HbA1c value is increased in the first trimester with 7.3% compared to 6.3% in the second and 6.4% in the third trimester. The placental weight fluctuated in the time period between 1960 and 2017. The highest average value was 637g for the decade between 2001 and 2010. The male fetal sex is a risk factor for placental histopathologic changes in healthy and T1DM pregnancies. In addition, placental oxidative and nitrative stress emerge in T1DM. Conclusion: The results show that even well controlled T1DM can lead to placental abnormalities. Although the results regarding the association between the maternal HbA1c at a specific time period and placental changes are inconsistent, it can be suggested that the first trimester HbA1c has a greater impact than the second or third trimester HbA1c. The correlation of pre-conceptional HbA1c value and placental abnormalities in T1DM has not been investigated yet. Therefore, further studies are needed to investigate a possible correlation. Placental oxidative and nitrative stress seems to be the underlying cause leading to structural vascular alterations.