title: Type 1, type 2 and gestational diabetes mellitus differentially impact placental pathologic characteristics of uteroplacental malperfusion.
abstract: BACKGROUND
  During a pregnancy complicated by diabetes, the placenta undergoes a number of functional and structural pathologic changes. However, differences across studies may reflect pathophysiologic differences of diabetes types under investigation.
  
  
  METHODS
  We examined placental pathology from women ages 18-40 years with self-identified race/ethnicity; singleton, live births; and type 1 (T1DM; n = 36), type 2 (T2DM; n = 37), or gestational diabetes mellitus (GDM; n = 126). Clinical data were abstracted from medical records. Placental diagnoses were independently re-reviewed by a perinatal pathologist. Multivariable analyses adjusting for race, gestational weight gain, gestational age, and systolic blood pressure were conducted.
  
  
  RESULTS
  Women with T1DM compared with either T2DM or GDM had higher gestational weight gain (mean ± SD, T1DM vs. T2DM: 28.5 ± 12.4 vs. 20.5 ± 13.4 kg, p = 0.03; or GDM: 21.3 ± 12.7 kg, p = 0.009) and insulin use (T2DM: 100.0% vs. 85.3%, p = 0.02; or GDM: 4.0%, p < 0.001). Women with T1DM compared with either T2DM or GDM also had a similarly lower prevalence of placental infarcts in univariate analyses; however, these findings did not remain significant after multivariable adjustment. Also, placentas from women with T2DM compared to GDM had higher rates of decidual vasculopathy when excluding women with preeclampsia (10.3 vs. 1.6%, p = 0.049) and diffuse chorangiosis (62.2 vs. 32.5%, p < 0.001) but a lower rate of villous immaturity (10.8 vs. 90.5%, p = 0.007) after full adjustment.
  
  
  CONCLUSIONS
  Placental vasculopathic abnormalities differ by maternal diabetes type, potentially reflecting underlying pathophysiologic mechanisms. Further research on placental pathology and metabolic derangements is warranted.
authors: Medicine/Diabetes Unit, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors: Jennifer
authors: J
authors: Huynh
authors: Medicine/Diabetes Unit, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors: Jessica
authors: J
authors: Yamada
authors: Medicine/Diabetes Unit, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors: Catherine
authors: C
authors: Beauharnais
authors: Medicine/Division of Nephrology, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors: Julia B
authors: JB
authors: Wenger
authors: Medicine/Division of Nephrology, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors: Ravi I
authors: RI
authors: Thadhani
authors: Medicine/Diabetes Unit, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors: Deborah
authors: D
authors: Wexler
authors: Medicine/Division of Pathology, Massachusetts General Hospital, Boston, MA, 02114, USA.
authors: Drucilla J
authors: DJ
authors: Roberts
authors: Medicine/Diabetes Unit, Massachusetts General Hospital, Boston, MA, 02114, USA. Electronic address: rbentleylewis@mgh.harvard.edu.
authors: Rhonda
authors: R
authors: Bentley-Lewis
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology / Q000503:physiopathology; D016640:Diabetes, Gestational / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D010920:Placenta / Q000098:blood supply / Q000473:pathology*; D021041:Placental Circulation; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000473:pathology* / Q000503:physiopathology; D012189:Retrospective Studies
keywords: Gestational diabetes mellitus; Placental pathology; Type 1 diabetes mellitus; Type 2 diabetes mellitus; Vasculopathy