Fetal vascular malperfusion score is linked with developing preeclampsia in women with gestational diabetes mellitus: a retrospective cohort study

Afsar, Selim; Turan, Gulay; Sonmez, Ayse Yigit; Usta, Ceyda Sancakli; Usta, Akın

doi:10.1590/1806-9282.20230795

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Original Article • Rev. Assoc. Med. Bras. 69 (12) • 2023 • https://doi.org/10.1590/1806-9282.20230795 copy

Fetal vascular malperfusion score is linked with developing preeclampsia in women with gestational diabetes mellitus: a retrospective cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Fetal vascular malperfusion is associated with poor perinatal outcomes in women with preeclampsia and gestational diabetes mellitus. The aim of this study was to determine the association between fetal vascular malperfusion score and syncytiotrophoblast basement membrane thickness and clinicopathological variables, such as developing preeclampsia in women with gestational diabetes mellitus.

METHODS:

This retrospective cohort study included 65 pregnant participants (34 with gestational diabetes mellitus and 31 controls) between January 2019 and January 2022. Gestational diabetes mellitus was diagnosed as ≥2 of 4 elevated values on a 3-h, 100-g oral glucose tolerance test. The fetal vascular malperfusion score was evaluated by endothelial CD34 positivity in the villous stroma of the placenta. The association between fetal vascular malperfusion score and syncytiotrophoblast basement membrane thickness with clinicopathological variables in women with gestational diabetes mellitus was evaluated.

RESULTS:

It was revealed that the gestational diabetes mellitus group had greater fetal vascular malperfusion scores than the control group (gestational diabetes mellitus group fetal vascular malperfusion score: 34.2±9.1 and control group fetal vascular malperfusion score: 26.5±8.7, respectively, p=0.0009). Syncytiotrophoblast basement membrane thickness was correlated with the development of preeclampsia, trophoblast proliferation, and fetal vascular malperfusions (0.3952, p=0.0129; 0.3487, p=0.0211; and 0.4331, p=0.0082, respectively). On the contrary, fetal vascular malperfusions were correlated with the development of preeclampsia, villous edema, and trophoblast proliferation (0.3154, p=0.0343; 0.2922, p=0.4123; and 0.3142, p=0.0355, respectively).

CONCLUSION:

The gestational diabetes mellitus group displayed significantly higher fetal vascular malperfusion scores and thickening of the syncytiotrophoblast basement membrane than the control group. There is a correlation between developing preeclampsia and the fetal vascular malperfusion scores and the syncytiotrophoblast basement membrane thickness.

KEYWORDS:
Diabetes; gestational; Chorionic villi; Antigens; CD34; Pre-eclampsia

Participants’ characteristics	GDM (n=34)	Control (n=31)	p-value
Age (years), median	30.5 (24–40)	29 (22–42)	0.47
Parity (n)	1 (0–3)	1 (0–4)	0.91
Fasting blood glucose (mg/dl)	88.5 (68–121)	76 (67–94)	0.09
Gestational age (weeks)	38 weeks+3 days	38 weeks+2 days	0.32
Fetal macrosomia^a a Fetal macrosomia is defined as birth weight >4,000 g16. , n (%)	6 (17%)	2 (6%)	0.17
Neonatal hypoglycemia^b b According to the AAP Neonatal Hypoglycemia Guideline17. , n (%)	3 (8%)	0	0.09
Developing preeclampsia^c c According to the ACOG Preeclampsia Guideline 202018. , n (%)	3 (8%)	0	0.09
Fetal weight (g)	3,390 (2,450–5,150)	3,320 (2,850–4,210)	0.43

Participants’ characteristics		GDM (n=34)	Control (n=31)	p-value
Placental weight (g)		538 (365–750)	489 (398–577)	0.23
Umbilical cord insertion
	Central	30	28	0.13
	Marginal	4	3	0.18
Villous immaturity		33/34 (97%)	18/31 (58%)	0.0002 ^* ***** p<0.001.
Villous edema		7 (21%)	5 (16%)	0.64
Fibrin thrombus		11 (32%)	9 (29%)	0.76
Trophoblast proliferation		30/34 (88%)	19/31 (61%)	0.01 ^* * p<0.05,
Trophoblast BM thickness		27/34 (79%)	10/31 (32%)	0.0002 ^* ***** p<0.001.
FVM score		34.2±9.1	26.5±8.7	0.0009 ^* ***** p<0.001.

GDM group	FVM score		Trophoblast BM thickness
Variables	ρ-coefficient	p-value	ρ-coefficient	p-value
Fasting blood glucose	0.202	0.09	0.124	0.21
Neonatal hypoglycemia^a a According to the AAP Neonatal Hypoglycemia Guideline16.	0.123	0.36	0.115	0.31
Preeclampsia^b b According to the ACOG Preeclampsia Guideline 202017.	0.315	0.03 ^* * p<0.05,	0.395	0.01 ^* * p<0.05,
Fetal weight	0.154	0.12	0.214	0.06
Villous immaturity	0.104	0.19	0.042	0.62
Villous edema	0.292	0.41	0.151	0.11
Fibrin thrombus	0.185	0.31	0.119	0.30
Trophoblast proliferation	0.314	0.03 ^* * p<0.05,	0.348	0.02 ^* * p<0.05,
FVM score			0.433	0.008 ^ p<0.01.

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[1] *Corresponding author: drselim@istanbul.edu.tr