Microanatomical Alterations of Placenta in Gestational Diabetes Mellitus: Comparative Analysis of Lean and Obese Pregnancies in a Central Indian Cohort
Snehal A. Deulkar, A. M. TarnekarAbstract
Background:
Gestational diabetes mellitus (GDM) and maternal obesity significantly influence placental structure and function, impacting maternal and fetal outcomes. Although morphological changes in GDM placentas are documented, comparative evaluation of lean and obese GDM subgroups remains limited. The objective of this study was to identify microanatomical alterations and assess the effect of glycemic control in placentas of women with GDM versus normoglycemia, with emphasis on differences between lean and obese GDM subgroups.
Methodology:
This observational study was conducted at tertiary care centers in the Central Vidarbha region, India. The pregnant women in their first trimester were enrolled and grouped as Non-GDM (body mass index [BMI] ≤22.9,
Results:
Histopathological analysis of 120 placentas revealed a significant increase in fibrinoid necrosis, syncytial knot formation, villous edema, and calcification in both the GDM groups and controls. Multivariate analysis identified maternal BMI >30 kg/m 2 and average blood glucose >140 mg/dl as independent predictors of severe placental pathological changes.
Conclusions:
GDM is associated with notable microanatomical placental alterations, with progressive severity from lean-to-obese diabetic pregnancies. The consistent presence of fibrinoid necrosis and increased syncytial knots, along with higher cesarean rates, indicates marked placental dysfunction. These findings highlight obesity’s exacerbating effect on GDM-related placental changes and emphasize the need for intensified monitoring in obese GDM pregnancies.