Does a First-Degree Family History of Diabetes Impact Placental Maternal and Fetal Vascular Circulation and Inflammatory Response?

CONTEXT: Heritability of diabetes is associated with hyperinsulinemia, impaired endothelial function, and inflammatory up-regulation. However, no studies have examined whether a family history of diabetes (FHD) effects placental vascular circulation.

OBJECTIVE

The current study was designed to investigate the impact of a first-degree FHD on placental vascular circulation and inflammatory lesions.

DESIGN

Observational cohort study.

SETTING

Pregnant women who gave birth at Edith Wolfson Medical Center.

PATIENTS: Three hundred thirty-nine pregnant women were divided into two groups according to presence of FHD: group 1 included 225 subjects without FHD, and group 2 included 114 subjects with FHD.

INTERVENTION: Placental histopathological examination.

MAIN OUTCOME MEASURES: Placental vascular supply abnormalities of maternal and fetal origin.

RESULTS

Maternal vascular supply (MVS) abnormalities of the placenta were significantly higher in subjects with FHD, compared with subjects without FHD (P < 0.005). Fetal vascular supply abnormalities, as well as maternal and fetal inflammatory response did not differ significantly between groups. In the general linear modeling analysis, FHD was an independent and significant predictor of MVS abnormalities and more than doubled the risk of this outcome. Gestational diabetes mellitus (GDM) incidence was significantly higher in subjects with FHD (P < 0.0001). Significant by-group differences in GDM persisted even after adjustment for age and body mass index. Although incidence of gestational hypertensive disorders was significantly higher in individuals with FHD, after adjustment FHD did not significantly predict this outcome.

CONCLUSIONS

A first-degree FHD is significantly and independently associated with an increased rate of maternal vascular perfusion abnormalities and risk of GDM.