Differences in post-mortem findings after stillbirth in women with and without diabetes

• Published in: Diabetic medicine Vol. 30; no. 10; pp. 1219 - 1224
• Main Authors: Edwards, A., Springett, A., Padfield, J., Dorling, J., Bugg, G., Mansell, P.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.10.2013; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Autopsy; Biological and medical sciences; Birth Weight; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - pathology; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - pathology; Diabetes, Gestational - epidemiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gestational Age; Humans; Hypertension - epidemiology; Hypertension - pathology; Infant, Newborn; Medical sciences; Organ Size; Placenta - blood supply; Placenta - pathology; Placenta Diseases - epidemiology; Placenta Diseases - pathology; Pregnancy; Pregnancy in Diabetics - epidemiology; Prevalence; Risk Factors; Stillbirth - epidemiology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Endocrinopathy; Human; Obesity; Stillborn; Nutrition; Diabetes mellitus; Nutrition disorder; Postmortem; Metabolic diseases; Death in utero; Female; Woman; Endocrinology; Nutritional status; Comparative study
• ISSN: 0742-3071; 1464-5491; 1464-5491
• DOI: 10.1111/dme.12272

Aims The reason for the fivefold increased risk of stillbirth in women with diabetes is not known. Further understanding of the underlying mechanisms may facilitate identification of pregnancies at increased risk. We have compared post‐mortem reports in matched pairs of stillbirths in women with and without diabetes. Methods Post‐mortem reports were provided by the Centre for Maternal and Child Enquiries. Stillbirths as a result of lethal congenital and genetic abnormalities were excluded. Whole body, placenta and organ weights and histo‐pathological findings in cases and controls were compared and also related to published reference values. Results We analysed post‐mortem reports on 23 matched pairs of stillbirths from 2009 to 2010. Mean placental weight in women with diabetes was 75 g less than in control subjects (95% CI −143 to −7 g; P = 0.032). In maternal diabetes, the thymus was often small and showed a ‘starry sky’ pattern on histology in 11 of 20 cases compared with four of 22 controls (P = 0.03). This histological finding was associated with a particularly low mean placental weight z‐score −2.1 (1.1) standard deviations below a reference population corrected for gestational age. Conclusions In over half of the stillbirths occurring in women with diabetes, there was a ‘starry sky’ appearance in the fetal thymus on histology, this being associated with a small placenta. These findings are consistent with a critical subacute metabolic disturbance being a prominent cause of the increased risk of stillbirth in pregnancies complicated by maternal diabetes. What's new? This is the first study of post‐mortem findings after stillbirth in women with maternal diabetes compared with matched control subjects. The results of the study indicate that approximately one half of stillbirths in women with diabetes may be attributable to a subacute metabolic disturbance, often occurring in association with a small placenta. The findings are of potential interest in understanding the cause of the increased incidence of stillbirth in women with diabetes.