Macroscopic placental changes associated with fetal and maternal events in diabetes mellitus

OBJECTIVES: The current study sought to identify macroscopic placental changes associated with clinical conditions in women with or without diabetes and their newborns. METHODS: The study population consisted of 62 pregnant women clinically diagnosed with diabetes and 62 healthy women (control group). RESULTS: Among the subjects with diabetes, 43 women (69.3%) were diagnosed with gestational diabetes mellitus, 15 had diabetes mellitus I (24.2%), and four had diabetes mellitus II (6.5%). The mean age of the women studied was 28.5 ± 5.71 years, and the mean gestational age of the diabetic women was 38.51 weeks. Of the 62 placentas from diabetic pregnancies, 49 (79%) maternal surfaces and 59 (95.2%) fetal surfaces showed abnormalities, including calcium and fibrin deposits, placental infarction, hematoma, and fibrosis. A statistical association was found between newborn gender and fetal and maternal placental changes (p = 0.002). The mean weight of the newborns studied was 3,287 ± 563 g for women with diabetes mellitus, 3,205 ± 544 g for those with gestational diabetes mellitus, 3,563 ± 696 g forthose with diabetes mellitus II, and 3,095 ± 451 g forthose with diabetes mellitus I. CONCLUSIONS: Infarction, hematoma, calcification, and fibrin were found on the maternal and fetal placental surfaces in women with diabetes. Women with gestational diabetes and post-term infants had more calcium deposits on the maternal placental surface as compared to those with type I and type II diabetes.

Fatores maternos e neonatais associados à prematuridade / Maternal and neonatal factors associated with prematurity / Factores maternos y neonatales asociados a prematuridad

A prematuridade representa a causa mais freqüente de morbidade neonatal. O objetivo desse estudo foi realizar um levantamento dos nascimentos de recém-nascidos vivos com menos de 37 semanas completas de gestação e relacionar com as alterações patológicas encontradas. Foram coletados dados referentes à história clínica materna e do neonato. A média da idade gestacional dos 104 RNs estudados foi de 31 semanas ± 4 dias. A média de peso dos prematuros foi de 2350 gramas. Os grupos de doenças de base maternas encontradas foram: hipertensão materna 51 casos (49%), alterações útero-placentárias 21 casos (20,1%), doenças infecciosas 12 casos (11,5%), cardiopatias 9 casos (5,7 %), diabetes 2 casos (1,9%), Síndrome da Imunodeficiência Adquirida 1 caso (0,9%) ainda 8 casos (7,6%) em que não havia registro de doença de base. Entre os grupos de doenças de base fetais o mais frequente foi o grupo de doenças do aparelho respiratório, com 81 casos (78%). Em nosso estudo, houve diferença estatisticamente significante entre idade gestacional e doença de base materna (p=0,038). A prematuridade continua sendo a principal causa de morbidade e mortalidade neonatal, representando um dos maiores desafios para o fornecimento de uma assistência profissional de qualidade.

The prematurity is the most frequent cause of neonatal morbidity. The aim of this search was to perform a survey of thenewborns with less than 37 completed weeks of gestation and related with the pathological alterations found. The data wascollected from the maternal and neonatal medical record. The mean gestational age of the 104 newborns studied was 31weeks ± 4 days. The mean weight of the premature infants in our study was 2350 grams. The groups with maternal baselinediseases were: maternal hypertension 51 cases (49%), uterus-placental disorders 21 cases (20.1%), infectious diseases 12cases (11.5%), heart diseases 9 cases (5.7 %), diabetes 2 cases (1.9%), Acquired Immune Deficiency Syndrome 1 case(0.9%) and 8 cases (7.6%) with no record of the baseline disease. Among the groups with fetal baseline diseases the mostfrequent diseases were of the respiratory tract, with 81 cases (78%). In our study, there was statistically significantdifference between gestational age and maternal baseline disease (p=0038). The prematurity remains the main cause ofneonatal morbidity and mortality, being one of the biggest challenges for the provision of professional high quality assistance.

El nacimiento prematuro representa la causa más frecuente de morbilidad neonatal. Objetivo: realizar un levantamiento delos nacimientos de recién nacidos vivos con menos de 37 semanas completas de gestación y relaciona con las modificacionespatológicas encontradas. Se recolectaron los datos referentes a historia clínica materna y del neonato. La media de la edadgestacional de los 104 recién nacidos estudiados fue de 31 semanas±4 días. De los 104 casos estudiados, 82 casos (78,8 %)habían sido acompañados durante el prenatal. La media de peso de los prematuros fue de 2350 gramos. Los grupos deenfermedades de base maternas encontradas fueron: hipertensión materna 51 casos (49%), alteraciones útero-placentarias21 casos (20,1%), enfermedades infecciosas 12 casos (11,5%), cardiopatías 9 casos (5,7 %), diabetes 2 casos (1,9%),Síndrome de Inmunodeficiencia Adquirida 1 caso (0,9%) además de 8 casos (7,6%) en que no habían registros deenfermedades de base. Entre los grupos de enfermedades de base fetales las más frecuentes fueron las del grupo deenfermedades del sistema respiratorio, con 81 casos (78%). En nuestro estudio, hubo diferencias estadísticamentesignificativas entre edad gestacional y enfermedad de base materna (p=0,038). La prematuridad continúa siendo la principalcausa de morbilidad y mortalidad neonatal.