Preeclampsia in pregnancies with and without diabetes: the associations with placental weight. A population study of 655 842 pregnancies

Improved neonatal outcomes in pregnancies with coexisting gestational diabetes and preeclampsia in normal birthweight neonates- insights from a retrospective cohort study

INTRODUCTION

We aimed to assess neonatal and maternal outcomes in appropriate-for-gestational-weight (AGA) neonates of mothers with both gestational diabetes mellitus (GDM) and preeclampsia (PET).

METHODS

Medical records of women diagnosed with GDM or PET were reviewed. Women with AGA neonates were divided into three groups- GDM, PET, and GDM + PET and maternal neonatal and placental outcomes were compared. The primary outcome was a composite of adverse neonatal outcomes, including intensive care unit admission (NICU), neurological morbidity, hypoglycemia, ventilation, respiratory distress syndrome (RDS), phototherapy, sepsis, blood transfusion, and neonatal death. Post-hoc analysis was performed to determine between-group significance.

RESULTS

Composite adverse neonatal outcomes are significantly lower in women with multiple morbidities compared to women with confined PET (p = 0.015), and a similar trend is observed when comparing neonatal outcomes between women with GDM to those with GDM + PET, yet these results are underpowered (18.9 % vs. 12.8 % respectively, p = 0.243). Placentas of women with GDM + PET were larger, with a lower rate of placentas below the 10th percentile as compared to placentas of women with isolated PET (p < 0.001), but with similar rates of MVM lesions.

DISCUSSION

While maternal and placental outcomes in patients of the GDM + PET group resemble the characteristics of the PET group, surprisingly, the neonatal outcomes in this group are significantly better compared to isolated morbidities. The paradoxical benefit attributed to the coexistence of GDM + PET may be explained by a balance of the opposing trends characterizing these morbidities-the reduced blood and nutrient supply characterizing PET vs. chronic overflow and abundance typical of GDM.

CLINICAL TRIAL REGISTRATION

approval of local ethics committee WOMC-19-0152.

Inter-pregnancy interval and placental weight. A population based follow-up study in Norway

INTRODUCTION

We studied changes in placental weight from the first to the second delivery according to length of the inter-pregnancy interval.

METHODS

We followed all women in Norway from their first to their second successive singleton pregnancy during the years 1999-2019, a total of 271 184 women. We used data from the Medical Birth Registry of Norway and studied changes in placental weight (in grams (g)) according to the length of the inter-pregnancy. Adjustments were made for year and maternal age at first delivery, changes in the prevalence of maternal diseases (hypertension and diabetes), and a new father to the second pregnancy.

RESULTS

Mean placental weight increased from 655 g at the first delivery to 680 g at the second. The adjusted increase in placental weight was highest at inter-pregnancy intervals <6 months; 38.2 g (95 % CI 33.0g-43.4 g) versus 23.2 g (95 % CI 18.8g-27.7 g) at inter-pregnancy interval 6-17 months. At inter-pregnancy intervals ≥18 months, placental weight remained higher than at the first delivery, but was non-different from inter-pregnancy intervals 6-17 months. Also, after additional adjustment for daily smoking and body mass index in sub-samples, we found the highest increase in placental weight at the shortest inter-pregnancy interval. We estimated no difference in gestational age at delivery or placental to birthweight ratio according to inter-pregnancy interval.

DISCUSSION

Placental weight increased from the first to the second pregnancy, and the increase was most pronounced at short inter-pregnancy intervals. The biological causes and implications of such findings remain to be studied.

Is the risk of cardiovascular disease in women with pre-eclampsia modified by very low or very high offspring birth weight? A nationwide cohort study in Norway

OBJECTIVES

To examine whether the risk of cardiovascular disease (CVD) in women with pre-eclampsia is modified by very low or very high offspring birth weight. Further, we studied whether diabetes in pregnancy modified this risk.

DESIGN

Nationwide cohort study.

SETTING

Norwegian population registries.

PARTICIPANTS

618 644 women who gave birth to their first child during 1980-2009.

METHODS

The women were followed from delivery until the development of CVD or censoring, by linkage of the Medical Birth Registry of Norway to the Cardiovascular Disease in Norway project, and the Norwegian Cause of Death Registry.

PRIMARY OUTCOME MEASURE

CVD.

RESULTS

Compared with normotensive women with normal offspring birth weight, women with pre-eclampsia had increased risk of CVD (HR 2.16; 95% CI 2.05 to 2.26). The CVD risk was even higher when pre-eclampsia was accompanied with a large for gestational age offspring (LGA, z-score >2.0) (HR 2.57; 95% CI 2.08 to 3.18). Women with pre-eclampsia and a small for gestational age offspring (SGA, z-score <-2.0) had an HR of 1.54 (95% CI 1.23 to 1.93) compared with normotensive women with normal offspring birth weight.Also, women with diabetes had increased CVD risk, but no additional risk associated with an LGA or SGA offspring.

CONCLUSIONS

Women with pre-eclampsia and an LGA offspring had higher risk of CVD than pre-eclamptic women with a normal weight (z-score -2.0 to 2.0) or SGA offspring. These findings suggest that factors causing pre-eclampsia and an LGA offspring are also linked to development of CVD.

Placental volume in gestational week 27 measured by three-dimensional ultrasound and magnetic resonance imaging

INTRODUCTION

Ultrasound is the diagnostic tool of choice in pregnancy. We lack valid ultrasound methods for placental size measurements. Our aim was therefore to compare three-dimensional (3D) ultrasound with magnetic resonance imaging (MRI) for measurements of placental volume.

MATERIAL AND METHODS

We measured placental volume by 3D ultrasound and MRI in 100 unselected pregnancies at 27 weeks of gestation (25⁺⁴ -28⁺⁴  weeks). The 3D ultrasound acquisitions were analyzed offline, and the placental outline was manually traced using the virtual organ computer-aided analysis (VOCAL) 30° rotational technique. The MRI examinations included a T2-weighted gradient echo sequence in the sagittal plane, with 5-mm slices through the entire uterus. The placental outline was manually traced in each slice. The correlation between 3D ultrasound and MRI placental volumes was estimated by intraclass correlation coefficients. Bland-Altman analysis was applied to visualize systematic bias and limits of agreement, in which the ratio MRI placental volume/3D ultrasound placental volume was plotted against the average of the two methods.

RESULTS

The intraclass correlation coefficient between 3D ultrasound and MRI measurements was 0.49 (95% confidence interval 0.33-0.63). In general, 3D ultrasound measured smaller placental volumes (median 373 cm³ , interquartile range 309-434 cm³ ) than MRI (median 507 cm³ , interquartile range 429-595 cm³ ) and the systematic bias was 1.44. The 95% limits of agreement between the two methods were wide (0.68-2.21).

CONCLUSIONS

We found poor to moderate correlation between 3D ultrasound and MRI placental volume measurements. Generally, 3D ultrasound measured smaller placental volumes than MRI, suggesting that 3D ultrasound failed to visualize the entire placenta. Our findings may hopefully contribute to the improvement of ultrasound methods for placental measurements.

Temporal changes in fetal death risk in pregnancies with preeclampsia: Does offspring birthweight matter? A population study

Objectives

To study the associations of preeclampsia with fetal death risk within percentiles of offspring birthweight, and whether these associations have changed during 1967–2014.

Study design

In this population study, we included all singleton pregnancies in the Medical Birth Registry of Norway during 1967–2014 (n = 2 607 199). Odds ratios (ORs) for fetal death associated with preeclampsia were estimated within percentiles of birthweight by applying logistic regression analyses. We estimated ORs for the study period as a whole, and for the years 1967–1983 and 1984–2014.

Results

During the study period as a whole, preeclampsia increased the risk of fetal death, OR 2.73 (95% CI 2.57–2.89), and the fetal death risk associated with preeclampsia differed across percentiles of offspring birthweight. The overall risk of fetal death decreased during our study period, and the decrease was most prominent in preeclamptic pregnancies with low offspring birthweight (<1 percentile). Thus, in recent years, the risk of fetal death in pregnancies with low offspring birthweight was lower in preeclamptic than in non-preeclamptic pregnancies, OR 0.22 (95% CI 0.12-0.41). Only in pregnancies with offspring birthweight within the 10–90 percentiles, the risk of fetal death associated with preeclampsia remained significantly increased throughout the study period.

Conclusions

The decline in fetal death risk was most prominent in preeclamptic pregnancies with low offspring birthweight. The introduction of a national screening program for preeclampsia in the 1980s, and identification of growth restricted offspring by fetal ultrasonography, may explain our findings.