What are the other Names for this Condition? (Also known as/Synonyms)

• Placenta in Diabetic Mothers

What is Diabetic Placenta? (Definition/Background Information)

• Diabetic Placenta is a condition that affects women who either have pre-existing diabetes (prior to becoming pregnant) or develop diabetes during their pregnancy (gestational diabetes). In this condition, the placenta increases in size and is large for gestational age
• The placenta is an organ that connects the developing fetus to the uterine wall. It is a disc-shaped red-brown structure that connects the fetus to the mother through the umbilical cord. The normal function of placenta is to supply nutrients and oxygen to the fetus from the mother’s blood and remove wastes from the fetal body
• Women develop Diabetic Placenta when they have the condition known as gestational diabetes (also termed maternal diabetes). Gestational diabetes is a type of diabetes in which women have glucose intolerance during pregnancy (either pre-existing or acquired during pregnancy)
• It is characterized by high blood sugar/glucose that is usually diagnosed during pregnancy. Hormonal changes during pregnancy blocks insulin from performing its normal functions, thereby increasing blood glucose levels in pregnant women
• A diagnosis of Diabetic Placenta is made through testing blood glucose levels and glucose tolerance test. The condition is usually treated using a combination of diet modification and medication
• The prognosis of Diabetic Placenta is generally good with appropriate treatment and close monitoring of the pregnancy

Who gets Diabetic Placenta? (Age and Incidence)

• Gestational diabetes occurs in approximately 4% of all pregnancies
• Pregnant women, typically over the age of 25 years, are prone to Diabetic Placenta
• African American, Afro-Caribbean, native American, Hispanic, Pacific Islander or Asian women are more likely to have gestational diabetes (higher incidence rates noted)

What are the Risk Factors for Diabetic Placenta? (Predisposing Factors)

Women are at a greater risk for developing Diabetic Placenta, if they are diabetic and:

• Are older than 35 years of age, when pregnant
• Have a family history of the condition
• Have given birth to a baby weighing over 9 pounds (about 4 Kg)
• Have given birth to a baby with birth defects (in a previous pregnancy)
• Have or had gestational diabetes in a previous pregnancy
• Have high blood pressure (pre-eclampsia or eclampsia of pregnancy)
• Have an excess of amniotic fluid during pregnancy; a condition known as polyhydramnios
• Have polycystic ovary syndrome (PCOS), one of the most common female endocrine disorders
• Have been previously diagnosed with impaired glucose tolerance
• Have sugar in the urine (glucosuria)
• Have had an unexplained miscarriage or stillbirth earlier
• Were overweight before pregnancy with a body mass index (BMI) greater than 30 or more

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Diabetic Placenta? (Etiology)

The cause of Diabetic Placenta is abnormal blood glucose levels in the expectant mother during pregnancy.

• Gestational diabetes: Gestational diabetes is classically defined as having any degree of glucose intolerance with onset or first recognition during pregnancy
• Food taken into the body is broken down to produce glucose, which then enters the bloodstream. The pancreas produces the hormone, insulin, which facilitates the movement of glucose from the bloodstream to the cells
• During pregnancy, a woman’s placenta, connecting the baby to her blood supply, produces high levels of pregnancy-related hormones. Most of these pregnancy-related hormones impair the action of insulin in cells, raising blood sugar levels. 
• A modest elevation in blood glucose levels following a meal is normal during pregnancy. However, abnormal blood glucose levels or persistently elevated blood glucose levels results in gestational diabetes
• As the baby develops, the placenta produces more pregnancy-related insulin-blocking hormones. In gestational diabetes, the placental hormones cause an abnormal rise in blood glucose to a level that can affect the development of the baby and the placenta

What are the Signs and Symptoms of Diabetic Placenta?

In most cases of Diabetic Placenta, there are no symptoms. However, women may have symptoms related to diabetes. In many women, blood sugar levels are usually restored after delivery. However, in some, there may be persistent elevations in blood glucose levels resulting in a condition called post-gestational diabetes (postpartum diabetes).

In some cases, the signs and symptoms of gestational diabetes in the expectant mother may be significant and may include:

• Blurred vision
• Fatigue
• Frequent infections such as those of the bladder, vagina, and skin
• Increased thirst (polydipsia), frequent urination
• Nausea and vomiting (polyuria)
• Increased appetite
• Weight loss

An important sign for Diabetic Placenta is an abnormally enlarged placenta (for a gestational age) that may be visible on ultrasound studies.

How is Diabetic Placenta Diagnosed?

In a majority of women, the onset of gestational diabetes usually occurs halfway through pregnancy. A few tests and exams to help diagnose Diabetic Placenta in gestational diabetes include:

• Testing for HbA1c levels in blood
• Oral glucose tolerance test: All pregnant women should have a glucose tolerance test undertaken between weeks 24 and 28 of pregnancy, in order to test for gestational diabetes. A blood sugar level above 140 mg/dL is recognized as abnormal
• Once diagnosed with diabetes during pregnancy, the women can test their glucose levels at home. The most common testing method is by pricking the finger and using a drop of blood, which when placed in a machine (called a glucometer) gives a glucose reading. A record of the glucometer readings should be kept as a log for the healthcare provider
• Ultrasound scans may show placentomegaly (i.e., large placenta for gestational age)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Diabetic Placenta?

Most women with Diabetic Placenta in gestational diabetes deliver healthy babies. Women, in whom the blood sugar levels are not controlled, are at risk of developing medical problems that may affect the child too. In such situations, there is an increased likelihood that the pregnant woman may need a C-section delivery.

Complications for the mother may include:

• Pre-eclampsia or eclampsia: These are two serious pregnancy-related complications that can cause high blood pressure
  • Pre-eclampsia is a condition of hypertension and high urine protein levels during pregnancy
  • Eclampsia is characterized by the appearance of seizures in addition to the signs and symptoms of pre-eclampsia
• Increased likelihood of a miscarriage 
• Future risk for diabetes: If the woman has gestational diabetes during one pregnancy, she is more likely to develop it again, in a future pregnancy. The woman is also more likely to develop type 2 diabetes over time (i.e., as she ages)

Complications for the baby may include:

• Excessive birth weight: Extra glucose in the bloodstream crosses the placenta, causing the baby’s pancreas to produce an excess of insulin. As a result, the baby can grow to a large size (termed as macrosomia). Larger babies are more likely to become wedged in the birth canal, have birth injuries, or require a C-section for delivery
• Early (preterm) birth and respiratory distress syndrome: High blood glucose can increase the risk of early labor and delivery of the baby before the due date. Babies born prior to the due date may experience respiratory distress syndrome, a condition that causes breathing difficulties. The baby may need assistance to breath, until their lungs are fully mature
• Low blood sugar, or hypoglycemia, can develop in babies with mothers who have gestational diabetes, because their insulin is being produced at a high level. Severe hypoglycemia can cause seizures in a baby. This may be treated by adequate breastfeeding and through intravenous glucose solutions that has the potential to return a baby’s blood sugar back to normal levels
• Jaundice, a yellow discoloration of the skin and whites of eyes, may occur if the baby’s liver is not fully mature enough to break down bilirubin. Bilirubin is a substance formed when the body recycles old red blood cells
• Type 2 diabetes (later in life): Children, who have mothers with gestational diabetes, are at an inherent higher risk for developing obesity and type 2 diabetes later in their life
• Polycythemia, in which the baby has high red blood cell mass
• Hypocalcemia, defined as having too low blood calcium levels, as well as hypomagnesemia, or low blood magnesium levels
• Birth defects, which may affect major organs such as the brain or heart
• Shoulder dystocia, a situation in which the baby’s shoulders become trapped in the mother’s vagina, during vaginal delivery; this typically occurs for large-sized babies

In severe cases, the baby may die, if the mother is not treated properly for the condition.

How is Diabetic Placenta Treated?

There is no specific treatment of Diabetic Placenta. However, the goal of underlying gestational diabetes treatment is to keep blood glucose levels within normal ranges during the entire period of pregnancy, and for the growing baby to be healthy. Fetal monitoring should be performed as often as necessary, to check the size and health of the fetus.

• One of the procedures to assess fetal heath is called a non-stress test. This is a painless, simple test for a pregnant mother and her baby. During this test, an electric fetal monitor, a machine that hears and displays the baby’s heartbeat is placed on the abdomen
• Another method, called a biophysical profile (BPP), is a test that combines a non-stress test with an ultrasound study of the baby
  • Using this method, the physician can evaluate the baby’s heartbeat, movements, breathing, and muscle tone, determining if the baby is surrounded by an adequate amount of amniotic fluid
  • Based upon a scoring system, the test helps determine BPP score. This baby’s score on this exam indicates if the baby is receiving enough oxygen or not
  • When amniotic fluid levels are lower and the baby is not urinating enough, it usually indicates that the placenta may not be functioning normally
• Fetal movement monitoring: In this method, fetal movement counting is performed to count how often the baby kicks over a set period of time. Infrequent movements can be indicative that the baby is not receiving enough oxygen supply
• Women with gestational diabetes should monitor their diet, taking the following into consideration:
  • Fats and proteins should be taken in moderation
  • Carbohydrates in foods, such as fruits, vegetables, and complex carbohydrates, such as bread, cereal, pasta, and rice, should form part of the diet
  • Sugars, such as fruit juices, soft drinks, and pastries, should be consumed in less amounts
  • A professional dietician can help plan an optimal diet
• If careful management of one’s diet is not sufficient enough to control blood glucose levels, one may be prescribed oral diabetes medications or insulin therapy. Some physicians may prescribe oral blood sugar control medication such as glyburide
• Breastfeeding the child can help achieve post-pregnancy weight goals and help prevent type 2 diabetes or avoid obesity into the future

How can Diabetic Placenta be Prevented?

Diabetic Placenta may be prevented by following a few measures to help avoid or control gestational diabetes which include:

• In overweight women, reducing body mass index (BMI) to normal ranges, prior to pregnancy, decreases the risk of developing gestational diabetes
• Remaining active and eating healthy during pregnancy, to help avoid any glucose intolerance. Choosing foods that are high in fiber, but low in fat and calories. Focusing on eating plenty of fruits, vegetables, and whole grains. Exercising for a period of 30 minutes (most days of the week), to help remain active
• Start prenatal care early on and have regular prenatal visits to monitor one’s health during pregnancy. Prenatal screenings, between weeks 24-28 of pregnancy, aids in an early detection of gestational diabetes

What is the Prognosis of Diabetic Placenta? (Outcomes/Resolutions)

The prognosis of Diabetic Placenta depends on a variety of factors that are chiefly related to the severity of gestational diabetes and treatment response measures.

• A majority of the women with gestational diabetes have the ability to control their blood pressures and avoid any harm, either to themselves or to their baby. However, some of the women are at an increased risk of high blood pressures (eclampsia and pre-eclampsia)
• Women with gestational diabetes usually have larger babies at birth, increasing the chances of medical issues at the time of delivery. These medical issues may include:
  • Birth injury to the baby and the mother
  • Surgical complications, due to delivery by C-section; these are rare events, but may still take place
• Following its birth, the infant is expected to have periods of low blood sugar (hypoglycemia), during the first few days
• The mother’s high blood glucose levels often normalize following delivery. Post-delivery, women with gestational diabetes should be closely monitored. Nevertheless, several such women develop diabetes usually within 5-10 years after delivery
• Pregnant women with severe gestational diabetes are at an increased risk of death of the fetus (intrauterine fetal demise), which can be greatly reduced by regularly monitoring blood sugar levels and availing appropriate treatment measures
• Pregnant women who receive appropriate prenatal care for maternal diabetes have much better prognosis than women who do not receive adequate prenatal care. The prognosis of the newborn child is also dependent on the quality of prenatal care received by the expectant mother

Additional and Relevant Useful Information for Diabetic Placenta:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/pregnancy-related-disorders/