title: Gestational diabetes as one of the "great obstetrical syndromes"--the maternal, placental, and fetal dialog.
abstract: Gestational diabetes mellitus (GDM)-associated fetal and neonatal adverse outcome results from the metabolic milieu projected on the fetus via the placental interface. Therefore, it can be considered to be one of the great obstetrical syndromes. Placentas from GDM pregnancies differ from nondiabetic pregnancies by an increased placental to fetal ratio and by histological findings such as villous fibrinoid necrosis, villous immaturity, chorangiosis, and ischemic changes. While early onset diabetes is more associated with marked structural changes of the placenta, GDM that rises at late gestation is associated more with placental functional changes. These placental changes, causing increased intervillous diffusion distance of immature villi and placental size to perfusion mismatch, may predispose the fetus to chronic and acute changes in gas and nutrient exchange thus turning the placenta from being a "fetus protector" to a potential source of adverse outcome. Understanding placental changes and how they affect outcome is necessary in order to develop effective screening, prevention, and management approaches.
authors.affiliation: Department of Obstetrics, Gynaecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA; Beilinson Hospital for Women, Rabin Medical Centre, PetachTikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Rinat
authors.initials: R
authors.lastname: Gabbay-Benziv
authors.affiliation: Department of Obstetrics, Gynaecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: abaschat@umm.edu.
authors.forename: Ahmet A
authors.initials: AA
authors.lastname: Baschat
mesh_terms: D016640:Diabetes, Gestational / Q000473:pathology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008431:Maternal-Fetal Exchange / Q000502:physiology*; D010920:Placenta / Q000473:pathology / Q000503:physiopathology*; D011247:Pregnancy; D013577:Syndrome
keywords: gestational diabetes; great obstetrical syndromes; placenta; roots of disease