Pathophysiology of placenta and fetus in diabetes mellitus

Analysis of Renal Pathology Predictors in Tender-Age Infants: Cohort Study

Background. The early onset of nephropathies creates certain risk of early chronic kidney disease development with loss of function (especially in children with unfavorable intrauterine period), renal tissue dysplasia, congenital malformations and/or urodynamic disorders.

Objective. The aim of the study is to evaluate the role of ontogenesis factors in nephropathies development in tender-age infants with specification of the course features and kidneys morphometric parameters.

Methods. Cohort study was conducted. The study group included 69 children aged from 0 to 36 months with changes in the kidneys (compared to age-specific ones) according to ultrasound and/or urinary syndrome (leukocyturia, bacteriuria, proteinuria, etc.). The control group included 35 relatively healthy children of the same age. Comparative analysis of antenatal and postnatal medical history was carried out in both groups, as well as comparison of morphometric indicators of the urinary system organs at neonatal ultrasound screening. Pathological process onset was also considered in the group of children with nephropathies. The study was conducted during 2018–2021.

Results. Possible predictors of pathology process in children with early onset of nephropathies are: 1) maternal diseases: urinary system disorders (OR = 4.99), blood pathology, mainly anemia of the 2nd–3rd grade (OR = 6.94), cardiovascular system diseases (OR = 10.26), inflammatory diseases of genital tract (OR = 10.61); 2) pregnancy failures: gestational diabetes mellitus (OR = 7.24), preeclampsia and eclampsia (OR = 4.40); placental pathology (OR = 17.0), and fetoplacental insufficiency (OR = 7.61); 3) feeding features: early conversion to breast-milk substitutes (OR = 2.81). 50.7% of children of this group has shown persistent urodynamic disorders already at first months of life according to ultrasound data, as well as signs of bloated kidneys. It was shown that the inflammatory process manifestation associated with aggravated perinatal history and congenital defects occurs significantly earlier — 2 months, and without any defects — 4 months (p = 0.004).

Conclusion. Burdened antenatal and neonatal medical history has negative effect on the morphogenesis of the urinary system organs and creates conditions for early nephropathies development during the first months of life.

[Uteroplacental blood flow in maternal diabetes mellitus]

Various uteroplacental blood flow disorders, their diagnosis, and correction, especially if the maternal obstetric history is burdened by endocrinopathy, still remain an urgent obstetric problem.

OBJECTIVE

To study blood flow in the vessel-red blood cell segment and to search for changes in both the vessels of the villous tree of the placenta and uterus and the properties of blood corpuscles, by using modern microscopy methods (scanning probe microscopy, atomic force microscopy).

MATERIAL AND METHODS

For macroscopic and microscopic examinations, fragments of the placenta, umbilical cord, and uterus were taken; venous blood samples were collected from patients without endocrinopathy, with gestational diabetes mellitus (GDM) or type 1 and type 2 diabetes mellitus (DM) prior to delivery. The data were statistically processed using both parametric (Student's t-test) and nonparametric (Fisher's exact test) methods.

RESULTS

The authors found that microangiopathy and other metabolic changes in diabetes mellitus could lead to villous stromal sclerosis, the appearance of intermediate villi, changes in blood vessel shape, relief tortuosity, depth, and area, endothelial cell destruction, stasis, and thrombosis. In these endocrinopathies, there were also changes in maternal red blood cells: their polymorphism was observed and geometric parameters and deformability were impaired. In this case, cell shape impairment correlated with the severity of the above described vascular complications.

CONCLUSION

The use of modern microscopy methods makes it possible to diagnose uteroplacental blood flow changes even in early pregnancy and to prevent the progression of uteroplacental blood flow disorders and placental insufficiency.