Effect of pregestational diabetes mellitus on first trimester placental characteristics: three-dimensional placental volume and power Doppler indices.
OBJECTIVE
To investigate whether pregestational diabetes mellitus (DM) induces changes in vascular placental development detectable at first trimester.


METHODS
This was a prospective case-control study in 69 women with pregestational DM and 94 controls undergoing first-trimester combined screening for aneuploidies. Maternal characteristics, fetal nuchal translucency thickness, maternal serum pregnancy-associated plasma protein A (PAPP-A) and free β human chorionic gonadotrophin (β-hCG) were evaluated. Three-dimensional ultrasound was used to measure placental volume and three dimensional power Doppler (3D-PD) placental vascular indices including: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Pregnancy-associated hypertensive complications (PAHC) and perinatal outcomes were analyzed. The total group of diabetic women and the group of diabetic women without PAHC were compared separately with the control group.


RESULTS
3D-PD placental vascular indexes were significantly lower in women with DM than in controls (VI p = 0.007, FI p = 0.003 and VFI p = 0.04). These differences remained on excluding cases with PAHC in the DM group. No differences were found in placental volumes between the DM group and controls. Serum PAPP-A levels were also lower in diabetic women (p < 0.02) and negatively correlated with the degree of maternal metabolic control at first trimester.


CONCLUSIONS
Pregestational DM induces demonstrable alterations in first trimester placental development, with significantly reduced placental vascularization indices and PAPP-A values. This effect is independent of the later development of PAHC.
Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Tenerife, Universidad de La Laguna, Canary Islands, Spain. Electronic address: ngonzalezg@sego.es.
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Gonzalez Gonzalez
Departmento de Estadística, I.O. y Computación, Universidad de La Laguna, Tenerife, Canary Islands, Spain.
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Gonzalez Davila
Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Tenerife, Universidad de La Laguna, Canary Islands, Spain.
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Castro
Departamento de Obstetricia y Ginecología, Hospital Universitario de Canarias, Tenerife, Universidad de La Laguna, Canary Islands, Spain.
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Padron
Hospitén Global Care, Canary Islands, Spain.
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Plasencia
D000328:Adult; D016022:Case-Control Studies; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced; D021621:Imaging, Three-Dimensional; D010920:Placenta / Q000033:anatomy & histology* / Q000098:blood supply*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011254:Pregnancy in Diabetics / Q000503:physiopathology*; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism; D011446:Prospective Studies; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal
D018997:Chorionic Gonadotropin, beta Subunit, Human; D011266:Pregnancy-Associated Plasma Protein-A
Placental vascular indices; Placental volume; Pregestational diabetes mellitus; Three dimensional power Doppler ultrasonography