Placental anatomopathological characteristics and neonatal outcomes in twin pregnancies of women with gestational diabetes

Abstract

Objective: To investigate placental characteristics and birth conditions in twin pregnancies complicated by gestational diabetes. Methods: A descriptive cross-sectional study with retrospective analysis of clinical records and placental anatomopathological reports. The population consisted of pregnant women with twin pregnancies associated with gestational diabetes treated at a referral pediatric hospital in Houston, Texas, between 2012 and 2019. Maternal, neonatal, and placental variables were analyzed, including obstetric complications, birth conditions, and macroscopic placental abnormalities. Results: Twenty-six twin pregnancies with gestational diabetes were analyzed, totaling 52 newborns and 26 placentas. A high frequency of gestational hypertension (69.2%), pre-eclampsia (50%), and HELLP syndrome/eclampsia (30.8%) was observed. Among the neonates, prematurity was observed in 69.2%, low birth weight in 46.2%, and intrauterine growth restriction in 30.8%. Macroscopic placental abnormalities were identified in 50% of the samples, with fibrin deposition (46.2%), thrombi (42.3%), and hematomas (38.5%) being the most prominent. Despite the complications, neonatal vitality was preserved, with an Apgar score ≥7 at 5 minutes in 96.2% of the newborns. Conclusion: The association between twin pregnancy and gestational diabetes is related to the high frequency of maternal complications, prematurity, and placental abnormalities. These abnormalities reinforce the central role of the placenta in the pathophysiology of perinatal outcomes in this context.