Is gross morphology of placenta, umbilical cord, and neonatal outcome in well-controlled gestational diabetes mellitus pregnancy different? A case-control study
Background: The relation of placental gross morphology and the outcome of pregnancies complicated with diabetes mellitus in comparison with healthy pregnancies is not known. Identifying significant differences in pregnancy outcomes in Gestational Diabetes Mellitus (GDM) and healthy pregnancies by the means of morphologic measurements can induce the use of antenatal ultrasonography of placental parameters to predict pregnancy outcomes.
Objective: This study aimed to evaluate the relationship between placental morphological parameters of the placenta and cord and the outcomes of pregnancies complicated with diabetes mellitus.
Materials and Methods: In this case-control study, which was conducted at two referral perinatology center in Tehran between March 2017 and November 2018, 60 pregnant women with GDM who were controlled with either diet or insulin as the case group and 60 pregnant women without GDM as the control group were enrolled. The study population were selected from patients who had their prenatal care and delivery in Mahdieh and Shohadaye Tajrish Hospital. The data was collected by taking sickness history, using data from patients files, and measuring of placental and newborn parameters after delivery. GDM was diagnosed either by 75 gr or 100 gr oral glucose tolerance tests. Placenta parameters, umbilical cord features, and newborn outcomes were compared between the two groups.
Results: Placental weight, diameter, number of lobes, thickness, placental weight tonewborn weight ratio, place of umbilical cord insertion, length, coiling, and diameter of the umbilical cord are similar in two groups. Newborn weight, NICU admission, ABG, and Apgar score are also the same in well-controlled GDM pregnancy and pregnancy without GDM.
Conclusion: Good controlled GDM causes no difference in placental gross morphology and pregnancy outcome compared to a healthy pregnancy.
Key words: Placenta, Umbilical cord, Gestational diabetes mellitus.
 Albrecht SS, Kuklina EV, Bansil P, Jamieson DJ, Whiteman MK, Kourtis AP, et al. Diabetes trends among delivery hospitalizations in the US, 1994- 2004. Diabetes Care 2010; 33: 768–773.
 Gagnon AJ, McDermott S, Rigol−Chachamovich J, Bandyopadhyay M, Stray−Pedersen B, Stewart D, et al. International migration and gestational diabetes mellitus: a systematic review of the literature and meta−analysis. Paediatr Perinat Epidemiol 2011; 25: 575–592.
 Desoye G, Hauguel-de Mouzon S. The human placenta in gestational diabetes mellitus: the insulin and cytokine network. Diabetes care. 2007 Jul 1;30(Supplement 2):S120–6.
 Berceanu C, Tetileanu AV, Ofiţeru AM, Brătilă E, Mehedinţu C, Voicu NL, et al. Morphological and ultrasound findings in the placenta of diabetic pregnancy. Rom J Morphol Embryol 2018; 59: 175–186.
 Huynh J, Dawson D, Roberts D, Bentley-Lewis R. A systematic review of placental pathology in maternal diabetes mellitus. Placenta 2015; 36: 101–114.
 Hiden U, Desoye G. The placenta in a diabetic pregnancy. J Reproduktionsmed Endokrinol 2010; 7: 27–33.
 American Diabetes Association. Management of diabetes in pregnancy: Standards of medical care in diabetes-2019. Diabetes Care 2019; 42 (Suppl.): S165–S172.
 Strong Jr TH, Jarles DL, Vega JS, Feldman DB. The umbilical coiling index. American journal of obstetrics and gynecology 1994; 170: 29–32.
 Chitra T, Sushanth YS, Raghavan S. Umbilical coiling index as a marker of perinatal outcome: an analytical study. Obstet Gynecol Int 2012; 2012: 13689.
 Najafi L, Abedini A, Kadivar M, Khajavi A, Bordbar A, Noohi AH, et al. Gestational diabetes mellitus: the correlation between umbilical coiling index, and intrapartum as well as neonatal outcomes. J Diabetes Metab Disord 2019; 18: 51–57.
 Najafi L, Malek M, Abedini A, Kadivar M, Ebrahim Valojerdi A, Zahmatkesh E, et al. Prediction of postnatal abnormal coiling of the umbilical cord in gestational diabetes mellitus: a diagnostic accuracy study. J Matern Fetal Neonatal Med 2020; 33: 1107–1113.
 Najafi L, Khamseh ME, Kashanian M, Younesi L, Abedini A, Valojerdi AE, et al. Antenatal umbilical coiling index in gestational diabetes mellitus and non-gestational diabetes pregnancy. Taiwan J Obstet Gynecol 2018; 57: 487–492.
 Lateef RH. Adverse effects of gestational diabetes mellitus (GDM) on measurements of the umbilical cord and its vessels. Pak J Biol Sci 2015; 18: 346– 351.
 Ennazhiyil SV, Ramakrishnan PK, Akshara VR, Premlal KS, Chitra S, Benjamin W, et al. Effects of gestational diabetes mellitus on umbilical cord morphology: A comparative study. Journal of Clinical and Diagnostic Research 2019; 13: AC06–AC09.
 Arshad R, Kanpurwala MA, Karim N, Hassan JA. Effects of diet and metformin on placental morphology in gestational diabetes mellitus. Pak J Med Sci 2016; 32: 1522–1527.