Effect of insulin versus dietary restriction alone on umbilical cord and placental arterio-venous anastomoses in women with gestational diabetes mellitus

Valsalan ES, Jacob J, Kuriachan S, Kumar DM, Rakhesh LR

Pdf Page Numbers :- 174-178

Seema Valsalan E¹, Jumi Jacob², Sanitha Kuriachan², Mahesh Kumar D^3,* and Rakhesh LR⁴

¹Department of Anatomy, PK Das Institute of Medical Sciences, Vaniamkulam, Palakkad, Kerala 679522, India

²Department of Pharmacology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala 680005, India

³Department of Pharmacology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Edappally, Cochin, Kerala 682041, India

⁴Department of Pharmacology, Dr. Moopen's Medical College, Wayanad, Kerala 673577, India

*Corresponding author: Dr. Mahesh Kumar D, Department of Pharmacology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Edappally, Cochin, Kerala 682041, India. Email: saakethbhagat@gmail.com

Received 10 January 2024; Revised 19 February 2024; Accepted 28 February 2024; Published 6 March 2024

Citation: Valsalan ES, Jacob J, Kuriachan S, Kumar DM, Rakhesh LR. Effect of insulin versus dietary restriction alone on umbilical cord and placental arterio-venous anastomoses in women with gestational diabetes mellitus. J Med Sci Res. 2024; 12(2):174-178. DOI: http://dx.doi.org/10.17727/JMSR.2024/12-33

Copyright: © 2024 Valsalan ES et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Background: Gestational diabetes mellitus (GDM) induces structural alterations in the umbilical cord and placental vessels. This study aims to understand the potential impact of insulin therapy on arteriovenous anastomosis (AVA) in placenta and umbilical cord.

Materials and methods: We collected 52 normal and 59 GDM placentas and umbilical cords from the labour room. GDM specimens were categorized into those treated with diet (GDM-Diet) (n = 23) and those treated with insulin (GDM-Insulin) (n= 36). The umbilical cord was dissected near its insertion to expose the vessels, and arteriovenous anastomoses were documented. Tissues underwent processing and staining for microscopic confirmation of AV anastomosis. Comparison was done between normal and GDM specimens, and notably, between GDM-Diet and GDM-Insulin specimens.

Results: Our examination of 59 GDM and 52 normal placentas with attached umbilical cords revealed AV anastomoses in 24 cases. AV anastomosis was observed in 22 (37.3%, n= 59) GDM cases and 2 (3.8%, n=52) normal cases (p=0.0001). Among GDM-Insulin group umbilical cords, 10 (27.78%, n = 36) exhibited AV anastomoses, while GDM-diet specimens displayed a notably higher proportion, with 12 (52.17%, n = 23) demonstrating AV anastomoses (p = 0.05).

Conclusion: AV anastomoses are markedly more prevalent in the umbilical cords and placentas of individuals with GDM. Interestingly, within the GDM cohort, prevalence is significantly higher in those managed with diet. Our study highlights the association between GDM management strategies and AVC prevalence, emphasizing the importance of considering vascular dynamics in the management of GDM pregnancies.

Keywords: placenta; umbilical cord; fetal- maternal health; gestational diabetes mellitus