Clinical and ultrasound features of placental maturation in pre-gestational diabetic pregnancy.

BACKGROUND Pre-gestational diabetes (PGDM) is a significant cause of neonatal morbidity and mortality. Delayed villous maturation (DVM) is a placental diagnosis with increased risk of perinatal mortality. AIMS This study aimed to prospectively look at the incidence of DVM in a PGDM population compared to non-diabetic controls. Additionally, we analysed antenatal ultrasound and clinical markers for DVM in the diabetic population. STUDY DESIGN This is a prospective study. SUBJECTS Placentae of women with non-diabetic and PGDM pregnancies underwent detailed blinded histo-pathological examination. OUTCOME MEASURES Clinical data, including birth weight, peri-natal outcome, and, in PGDM group, glycaemic control and ultrasound findings, were obtained. RESULTS 77 non-diabetic women and 74 PGDM women consented to the study. The incidence of DVM in the PGDM group was higher than in the non-diabetic group (21/74 (28.4%) vs. 11/77 (14.3%) p=0.02; RR 1.98). In the PGDM group clinical and ultrasound markers were compared between the DVM group (n=21) and the non-DVM group (n=53). There was no difference in perinatal outcome nor glycaemic control between these two groups. CONCLUSION DVM, a placental finding with an increased risk of perinatal mortality, is increased in PGDM population compared to non-diabetic controls. No association was found with maternal glycaemic control. The presence of placental DVM was not associated with antenatal ultrasound parameters nor clinical perinatal outcome.