Histological and immunohistochemical changes in placental chorionic villi of patients with poorly controlled gestational diabetes

ABSTRACT

Normal placental development is essential for normal fetal development. The placenta is a complex fetal organ that plays pleiotropic roles during fetal growth. It separates the maternal and the fetal circulation. The placenta is exposed to the regulatory influence of the hormones, cytokines, growth factors, and substrates present in the circulation, and thus may be affected by changes in any of these. Gestational diabetes is one of the most prevalent medical complications of pregnancy and may cause increased fetal wastage. To study the structural changes in the placental chorionic villi of women with poorly controlled gestational diabetes in comparison with metabolically normal pregnant women. The study was carried out on placentas from 22 full-term pregnant women. All the women delivered at 38-40 weeks of gestation. Ten placentas were from normal uncomplicated pregnancies [control group] and the other 12 were from gestational diabetic pregnancies [diabetic group]. The placentas were processed and examined using light and electron microscopy. An immunohistochemical study using S100 protein antibody was carried out. In comparison with the control group, the placentas of poorly controlled gestational diabetic mothers showed an increase in syncytial knots, partial shedding of trophoblastic microvilli, and thickening of the basement membrane of the trophoblast. Fibrinoid necrosis, villous fibrosis, and dilated congested fetal blood vessels were also observed. The frequent appearance of Hofbauer cells [placental macrophages] was observed in the diabetic placenta in comparison with the control placenta. Positive diabetic trophoblastic and stromal cells for S100 protein antibodies were observed. It is concluded that poor control of diabetes during gestation may result in structural changes in the placentas, which may contribute toward fetal complications. Further research in this field may help in finding a solution for the evaluation of the destructive changes in diabetic placenta in the initial stages of pregnancy