MORPHOFUNCTIONAL CHANGES IN THE PLACENTA AND EXPRESSION OF THE ENDOTHELIAL MARKER CD34+ IN PREGNANT WOMEN WITH TYPE 1 AND 2 DIABETES MELLITUS
Main Article Content
Abstract
Despite significant advances in the care of pregnant women with type 1 and type 2 diabetes and the prevention of obstetric complications, perinatal morbidity and mortality remain a pressing issue.
The aim – of this study was to investigate morphofunctional changes in the placenta and the expression of the endothelial marker CD34+ in pregnant women with type 1 and type 2 diabetes and to establish a relationship with cytokine levels (IL-6, IL-8, IL-10) as predictors of perinatal complications.
Materials and Methods. This prospective, comparative, case-control study included an analysis of pregnancy outcomes in 41 women with diabetes mellitus, including type 1 – 22, type 2 – 19. The control group included 24 women with normal pregnancy and delivery without carbohydrate metabolism disorders. This included an assessment of pregnancy progression and perinatal outcomes, analysis of serum IL-6, IL-8, and IL-10 cytokine levels at 30,0-35,0 weeks of gestation, and pathological and immunohistochemical examination of the placenta, including determination of the endothelial marker CD34+.
Results and Discussion. Women with diabetes mellitus and perinatal complications had chronic subcompensated placental insufficiency, compared to the control group (100,0% and 8,3%, respectively, p = 0,001). Threshold concentrations of IL-10 in women with type 1 diabetes mellitus in the blood serum have been established, so a level of ≥ 3,0 pg/ml (RR = 4,79; p = 0,0002) increases the risk of perinatal complications, while in pregnant women with type 2 diabetes mellitus, significant predictors were IL-6 ≥ 1.8 pg/ml (RR = 5,04; p = 0,017), IL-8 ≥ 7,0 pg/ml (RR = 2,32; p = 0,0136), IL-10 ≥ 3.0 pg/ml (RR = 10,12; p = 0,0007). A relationship was revealed between morphological changes in the placenta, immunohistochemical study using the endothelial marker CD34+, the content of pro- and anti-inflammatory cytokines in the blood serum and clinical manifestations Placental disorders in women with pregestational diabetes mellitus.
Conclusion. Patients with pregestational diabetes mellitus require a multidisciplinary approach, beginning with pregnancy planning, risk stratification, and step-by-step prediction of perinatal complications and adverse outcomes. This approach aims to determine appropriate management strategies and the timing and mode of delivery, which in turn will help determine the path to improving perinatal outcomes.
Keywords
Article Details
Information about financing and conflict of interests
The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
How to Cite
References
1. Dedov II, Shestakova MV, Mayorov AYu, Mokrysheva NG, Andreeva EN, Bezlepkina OB, et al. Standards of Specialized Diabetes Care. Diabetes mellitus. 2023; 26(2S): 1-157. Russian (Дедов И.И., Шестакова М.В., Майоров А.Ю., Мокрышева Н.Г., Андреева Е.Н., Безлепкина О.Б., и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом //Сахарный диабет. 2023. Т. 26, № 2S. С. 1-157.) doi: 10.14341/DM13042
2. Kravchenko EN, Kuklina LV, Shevlyukova TP. Intrauterine infection: risk factors and diagnostic problems during pregnancy. Obstetrics and Gynecology: News. Opinions. Training. 2023; 11(4): 35-44. Russian (Кравченко Е.Н., Куклина Л.В., Шевлюкова Т.П. Внутриутробная инфекция: факторы риска и проблемы диагностики во время беременности //Акушерство и гинекология: Новости. Мнения. Обучения. 2023. Т. 11, № 4. С. 35-44.) doi: 10.33029/2303-9698-2023-11-4-35-44
3. Shaposhnikova EV, Bazina MI, Mencik MM, ShageevaEV, Shageev TA. Features of the course of pregnancy and delivery in patients with carbohydrate metabolism disorders. Russian Medical Jornal. Mother and Child. 2020; 3(3): 163-168. Russian (Шапошникова Е.В., Базина М.И., Менцик М.М., Шагеева Е.В., Шагеев Т.А. Особенности течения беременности и родоразрешение у пациенток с нарушениями углеводного обмена //Российский медицинский журнал. Мать и дитя. 2020. № 3(3). С. 163-168.) doi: 10.32364/2618-8430-2020-3-3-163-168
4. Sakvarelidze NYu, Tsakhilovа SG, Muradova VS, Zharkov NV, Zikova AS, Nasredinova VV. Fetoplacental Angiogenesis in Preeclampsia. Clinical and Morphological Aspects. Effective pharmacotherapy. 2020; 16(28): 6-11. Russian (Сакварелидзе Н.Ю., Цахилова С.Г., Мурадова В.С., Жарков Н.В., Зыкова А.С., Насрединова В.В. Фетоплацентарный ангиогенез при преэклампсии. Клинико-морфологические аспекты //Эффективная фармакотерапия. 2020. Т. 16, № 28. С. 6-11.) doi: 10.33978/2307-3586-2020-16-28-6-11
5. Kapustin RV, Kopteeva EV, Alekseenkova EN, Tsybuk EM, Arzhanova ON. Analysis of risk factors and structure of perinatal losses in pregnant women with diabetes mellitus. Doctor.Ru. 2021; 20(6): 46-52. Russian (Капустин Р.В., Коптеева Е.В., Алексеенкова Е.Н., Цыбук Е.М., Аржанова О.Н. Анализ факторов риска и структуры перинатальных потерь у беременных с сахарным диабетом //Доктор.Ру. 2021. Т. 20, № 6. С. 46-52.) doi: 10.31550/1727-2378- 2021-20-6-46-5
6. Kapustin RV, Kopteeva EV, Alekseenkova EN, Kovalchuk-Kovalevskaya OV, Rybachek AV, Arzhanova ON, Kogan IYu. Neonatal outcomes in maternal diabetes mellitus: analysis of data from the DAPSY study. Journal of Obstetrics and Women's Diseases. 2024; 73(2): 15-26. Russian (Капустин Р.В., Коптеева Е.В., Алексеенкова Е.Н., Ковальчук-Ковалевская О.В., Рыбачек А.В., Аржанова О.Н., Коган И.Ю. Неонатальные исходы при сахарном диабете у матери: анализ данных исследования DAPSY //Журнал акушерства и женских болезней. 2024. Т. 73, № 2. С. 15-26.) doi: 10.17816/jowd624553
7. Salimova ZN, Kamilova MYa, Rakhmatulloeva DM, Gulakova DM. Histological picture of placentas and features of CD34+ expression in chorionic vascular endothelial cells of pregnant women with anemia. Avicenna Bulletin. 2017; 3: 286-291. Russian (Салимова З.Н., Камилова М.Я., Рахматуллоева Д.М., Гулакова Д.М. Гистологическая картина плацент и особенности экспрессии CD34+ в клетках эндотелия сосудов хориона беременных с анемией //Вестник Авиценны. 2017. № 3. С. 286-291.) doi: 10.25005/2074-0581-2017-19-3-286-291
8. Nasyrov RA, Melnikova VF, Krasnogorskaya OL, Popova ED, Narkevich TA, Sidorova NA, et al. Principles of pathological studies in cases of perinatal death. Pediatrician. 2018; 9(3): 85-105. Russian (Насыров Р.А., Мельникова В.Ф., Красногорская О.Л., Попова Е.Д., Наркевич Т.А., Сидорова Н.А., и др. Принципы проведения патоморфологических исследований в случаях перинатальной смерти //Педиатр. 2018. Т. 9, № 3. С. 85-105.) doi: 10.17816/PED9385-105
9. Seroshtanova DN, Dudareva YuA, Dronov SV. The role of cytokines in predicting perinatal complications in pregnant women with pregestational diabetes mellitus. Siberian Medical Review. 2025; (5): 68-74. Russian (Сероштанова Д.Н., Дударева Ю.А., Дронов С.В. Роль цитокинов в прогнозировании перинатальных осложнений у беременных с прегестационным сахарным диабетом //Сибирское медицинское обозрение. 2025. № 5. С. 68-74.) doi: 10.20333/25000136-2025-5-68-74