Observational studyActa obstetricia et gynecologica Scandinavica2026
Placental pathology in gestational diabetes mellitus: Associations with neonatal outcomes and postpartum dysglycemia.
Observational study in Acta obstetricia et gynecologica Scandinavica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionGestational diabetes mellitus (GDM) is associated with adverse outcomes in both pregnancy and the postpartum period. Although placental pathology has been extensively studied in relation to neonatal complications, its relevance to maternal health after delivery remains less well defined. This study aimed to compare gross and histologic placental features between GDM and normoglycemic pregnancies according to the Amsterdam Placental Workshop Group Consensus Statement. It also evaluated associations between specific placental lesions and both neonatal outcomes and maternal dysglycemia at 6 weeks postpartum in the GDM cohort. MATERIAL AND
methodsThis prospective observational cohort study included 200 women with GDM and 100 normoglycemic women who delivered at term. Placental examination comprised gross and histologic evaluation of lesions classified according to the Amsterdam criteria, including maternal and fetal vascular malperfusion, as well as commonly reported non-classified lesions such as chorangiosis and delayed villous maturation (DVM). Neonatal outcomes assessed were large-for-gestational-age status, low 1-min Apgar scores (<7), and neonatal hypoglycemia. Postpartum maternal dysglycemia at 6 weeks was assessed using a 75-g, 2-h oral glucose tolerance test and classified as prediabetes or type 2 diabetes mellitus. Associations were evaluated using logistic regression analysis.
resultsPlacental lesions were significantly more common in GDM than in normoglycemic pregnancies. These included maternal vascular malperfusion (67.5% vs. 39.0%, p < 0.001), fetal vascular malperfusion (49.0% vs. 22.0%, p < 0.001), chorangiosis (51.0% vs. 11.0%, p < 0.001), and DVM (17.0% vs. 8.0%, p = 0.034). DVM was independently associated with large-for-gestational-age infants (adjusted odds ratio [aOR] = 2.54, 95% confidence interval [CI] = 1.03-6.24) and low 1-min Apgar scores (aOR = 4.59, 95% CI = 1.08-19.63). Chorangiosis was independently associated with maternal dysglycemia at 6 weeks postpartum (aOR = 2.33, 95% CI = 1.07-5.07), an association primarily driven by prediabetes (aOR = 2.74, 95% CI = 1.22-6.15). Gross placental measurements did not differ significantly between groups.
conclusionsGDM is associated with various placental abnormalities, including Amsterdam-classified and non-classified lesions. DVM was associated with adverse neonatal outcomes, whereas chorangiosis was associated with postpartum dysglycemia. Systematic placental examination may aid in identifying women at risk of future metabolic disease.
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