Chapter-20 Placenta in a Diabetic Pregnancy

BOOK TITLE: Clinical Guidelines for Management of Diabetes in Pregnancy

1. Saxena Pikee
2. Agarwal Kavita
Publishing Year
Author Affiliations
1. Lady Hardinge Medical College, New Delhi, India, Lady Hardinge Medical College and SSK Hospital New Delhi, India, Reproductive Biomedicine National Institute of Health and Family Welfare, New Delhi, Lady Hardinge Medical College and Suchitra Kripalani Hospital New Delhi, Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital, New Delhi, India
2. Lady Hardinge Medical College and Associated Hospitals, New Delhi, India, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
Chapter keywords
Placenta, diabetic pregnancy, gestational diabetes mellitus, GDM, tumor necrosis factor, TNF, leptin, interleukin-6, maternal diabetic environment, placental cytokines


Placenta forms a vital link between the mother and fetus. It is responsible for transferring of nutrients and gases from mother to the fetus, removal of wastes from the fetus, safeguards the fetus by filtering toxic and immunogenic substances, it synthesizes hormones, few proteins and it also causes metabolic alteration of maternal nutrients for the fetus. Placenta is a dynamic organ and undergoes changes throughout pregnancy. As the gestational age advances, there are specific periods of placental development which are modified due to metabolic insults caused by pregestational or gestational diabetes. During first trimester, pregestational diabetes modifies trophoblastic invasion, placental anchoring, uterine vascular remodeling, and vascular development. This chapter covers the effect of maternal diabetic environment, effects of fetal hyperinsulinemia, placental cytokines, and antidiabetic agents and placenta. The human placenta synthesizes a variety of cytokines which regulate insulin action in response to hyperglycemia. It includes tumor necrosis factor (TNF), leptin, and interleukin-6 (IL-6).

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