Placental abnormalities in type 1 and type 2 diabetes mellitus: A systematic review and metaanalysis of shear wave elastography

Date

2022

Authors

Gupta, Akhil
Immanuel, Jincy
Ho, Vincent
Dalal, Raiyomand
Symons, Patricia
Simmons, David

Journal Title

Journal ISSN

Volume Title

Publisher

Elsevier

Abstract

OBJECTIVE This study aimed to describe the placental changes occurring in women with preexisting diabetes mellitus and to determine if elastography can detect placental changes in vivo.


DATA SOURCES PubMed, Embase, Medline, and Cochrane were searched to identify English language studies published until July 2020.


STUDY ELIGIBILITY CRITERIA

  1. For key question 1, studies that described histopathologic changes in placentas from women with known diabetes mellitus and 2) for key question 2, those that described structural–placental changes detectable by elastography in high-risk pregnancies (eg, those complicated by preeclampsia and/or fetal growth restriction), were included.

METHODS For key question 1, we grouped placental pathologies using the Amsterdam International Consensus Group definitions. For key question 2, we conducted a metaanalysis including all data from studies reporting placental stiffness in meters per second (m/s) or kilopascals (kPa). The mean difference (95% confidence interval) was calculated using a random effects model.


RESULTS Data were extracted from 14 studies of placental histopathology in women with known diabetes. In this group, a wide variety of placental histopathologic changes are described, though none are considered pathognomonic. The histopathologic changes including maternal vascular malperfusion, fetal vascular malperfusion, and/or infectious/inflammatory/other changes were divided into 3 broad categories on the basis of presumed etiology. A total of 15 studies reported the placental stiffness scores in women with a high-risk pregnancy vs those with a normal pregnancy. Only 1 reported stiffness scores for placentas in women with preexisting diabetes mellitus (N<10 women). Pooled analysis of 14 studies with available data included 478 “high-risk pregnancies” and 828 control or healthy pregnancies. Maternal-derived pathologies resulted in higher placental stiffness (mean difference 4.5 kPa [95% confidence interval, 3.16–5.87]) compared with control or healthy pregnancies. Fetal-derived pathologies also resulted in higher placental stiffness (mean difference of 6.5 kPa [95% confidence interval, 1.08–11.86]) compared with control or healthy pregnancies.


CONCLUSION Shear wave elastography may provide an in vivo approximation of placental histopathology in women with certain kinds of high-risk pregnancies. A high-risk pregnancy may involve maternal- and fetal-derived pathologies. Further studies, particularly in women with preexisting diabetes, are needed to confirm this observation.

Description

Article originally published in American Journal of Obstetrics & Gynecology MFM, 4(6), 100736. English. Published online 2022. https://doi.org/10.1016/j.ajogmf.2022.100736

Keywords

Fetal growth restriction, Placenta, Placental histopathology, Preeclampsia, Preexisting diabetes mellitus, Stiffness

Citation

This is a published version of an article that is available at: https://doi.org/10.1016/j.ajogmf.2022.100736. Recommended citation: Gupta, A., Immanuel, J., Ho, V., Dalal, R., Symons, P., & Simmons, D. (2022). Placental abnormalities in type 1 and type 2 diabetes mellitus: A systematic review and metaanalysis of shear wave elastography. American Journal of Obstetrics & Gynecology MFM, 4(6), 100736. This item has been deposited in accordance with publisher copyright and licensing terms and with the author’s permission.

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