The Placenta in a Diabetic Pregnancy

Journal für Reproduktionsmedizin und Endokrinologie - Journal of Reproductive Medicine and Endocrinology 2010; 7 (1): 27-33

Volltext (PDF)    Summary    Abbildungen   




Keywords: insuline,  Invasion,  LIPID,  Plazenta,  Vaskularisierung,  insuline,  Invasion,  LIPID,  placenta,  vascularisation

Diabetes in pregnancy is associated with a derangement of hormones, cytokines, metabolites and growth factors in the maternal and foetal compartment. These may influence placental growth and development that are tightly regulated in time and space. The distinct effects of the diabetic environment depend on the time in gestation when diabetic insult occurs. Because of its establishment in the second half of gestation, gestational diabetes mellitus will influence placental processes in late gestation, whereas pre-gestational diabetes such as Type-I and Type-II diabetes may also affect processes in the first trimester. Altered placental function in pre-gestational diabetes may include changes in invasion ultimately leading to an enhanced risk of early pregnancy loss, growth restriction and pre-eclampsia, as well as a long-term stimulatory effect on placental growth leading to placentomegaly, which is frequently associated with diabetic pregnancies. Diabetes later in gestation affects vascularisation, storage of maternal nutrients in particular glycogen and lipids and may also enhance oxygen transfer. It is still unresolved if the placental alterations in diabetes ultimately contribute to or prevent the foetal phenotype often seen in diabetes i.e., excessive fetal fat accretion.