Abstract

Background: Forensic Pathology remains a mainstay in diagnosing all forms of fetal death including stillborn and it is an indispensable tool in the process of evaluating the underlying cause of death. Diabetes mellitus (DM) being a common clinical condition with hyperglycemic state, it has a major impact on the growing fetus during gestation causing several morbidities including still birth. Histopathological evaluation of the systemic organs yields adequate information of the etiopathogenesis for the cause of death thereby aiding clinicians to proceed with further management and counselling to the parents

Methodology: The study was conducted between 2012 to 2020 covering 25 cases. The cases were categorized into 2 groups like Diabetes in Pregnancy (Type 1 & Type 2 DM) and Gestational Diabetes Mellitus (GDM). Complete clinical data including diabetic profile were documented. Routine fetal autopsy procedure was performed and the major systemic organs involved in metabolism like Liver, kidney, pancreas and lungs were weighed and analyzed for histomorphological changes.

Results: The study analyzed 25 cases which showed 5 cases each in Type 1 & Type 2 DM and 10 cases in GDM. Renal changes in fetuses were prominent in GDM compared to other groups. Histomorphological changes in the form degenerative features in liver, pancreas and lungs were more in common in GDM

Conclusion: Gestational Diabetes mellitus stays as a rampant condition leading to major cause for still birth compared to Type 1 & 2 DM. It had been evident that GDM is not an homogenous set of disease and a subset of conditions especially pre-existing but left undiagnosed could be a potential risk for growing fetal malformations with subsequent organ failure and stillbirth Keywords: Fetal autopsy; Diabetes mellitus; Histomorphology; Still birth.

• 1.   World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO consultation. Part 1. Diagnosis and classification of diabetes mellitus. Geneva: WHO; 2011.
• 2.   Wong V, Lin A, Russell H. Adopting the new World Health Organization diagnostic criteria for gestational diabetes: How the prevalence changes in a high-risk region in Australia. Diabetes Res Clin Pract. 2017;129:148–53.
• 3.   Negrato C, Mattar R, Gomes M. Adverse pregnancy outcomes in women with diabetes. Diabetol Metab Syndr. 2016;4:41.
• 4.   Gabbay-Benziv R, Reece E, Wang F, et al. Birth defects in pregestational diabetes: Defect range, glycemic threshold and pathogenesis. World J Diabetes. 2015;6(3):481–88.
• 5.   Padmanabhan S, Zen M, Lee V, et al. Pre-existing diabetes in pregnancy. Minerva Endocrinol. 2017;41:122–37.
• 6.   Kamakeri NS, Ramalingappa CA, Vinayraju D. Study of perinatal autopsies in tertiary care hospital 20-year experience. Int J Reprod Contracept Obstet Gynecol. 2017;6(7):2914–8.
• 7.   Naik V, Babu P, Reddy ES, et al. Study of various congenital anomalies in fetal and neonatal autopsy. Int J Res Med Sci. 2015;3(5):1114–21.
• 8.   Neeha S, Kattimani SR, Mahanta AA, et al. An autopsy based descriptive study of the spectrum of pulmonary lesions encountered in fetal deaths at a tertiary care center. Indian J Pathol Microbiol. 2018;61(4):495–9.
• 9.   Zodpey S, Paul VK. State of India’s Newborns (SOIN) 2014 – A report. New Delhi: Public Health Foundation of India, AIIMS, and Save the Children; 2014.
• 10.   Pradhan R, Mondal S, Adhya S, et al. Perinatal autopsy: A study from India. J Indian Acad Forensic Med. 2017;35(1):10–3.
• 11.   Finkbeiner WE, Ursell PC, Davis RL. Autopsy Pathology: A Manual and Atlas. 2nd ed. Philadelphia: Saunders Elsevier; 2009. p. 9–11.
• 12.   D’costa GF, Chincholikar M, Patil Y. Trends in neonatal lung pathology. Bombay Hosp J. 2006;48:547–60.
• 13.   Dargaville PA, Copnell B; Australian and New Zealand Neonatal Network. The epidemiology of meconium aspiration syndrome: Incidence, risk factors, therapies, and outcome. Pediatrics. 2016;117(5):1712–21.
• 14.   Liu WF, Harrington T. Delivery room risk factors for meconium aspiration syndrome. Am J Perinatol. 2014;19(7):367–78.
• 15.   Hakverdi S, Güzelmansur I, Güngören A, et al. Evaluation of fetal autopsy findings in the Hatay region: 274 cases. Turk Patoloji Derg. 2012;28(2):154–61.
• 16.   Aghabiklooei A, Goodarzi P, Kariminejad MH. Lung hypoplasia and its associated major congenital abnormalities in perinatal death: An autopsy study of 850 cases. Indian J Pediatr. 2016;76(11):1137–40.
• 17.   Becroft DM, Thompson JM, Mitchell EA. Pulmonary interstitial hemosiderin in infancy: A common consequence of normal labor. Pediatr Dev Pathol. 2005;8(4):448–52.
• 18.   Agrons GA, Courtney SE, Stocker JT, et al. From the archives of the AFIP: Lung disease in premature neonates: Radiologic-pathologic correlation. Radiographics. 2015;25(4):1047–73.
• 19.   Winocour PH. Diabetes and chronic kidney disease: an increasingly common multi-morbid disease in need of a paradigm shift in care. Diabet Med. 2018;35(3):300–5.
• 20.   Guariguata L, Linnenkamp U, Makaroff LE, et al. Global estimates of hyperglycaemia in pregnancy: Determinants and trends. In: Rajendram R, Preedy VR, Patel VB, editors. Nutrition and Diet in Maternal Diabetes: An Evidence-Based Approach. Cham: Springer International Publishing; 2018. p. 3–15.
• 21.   Alfadhli EM. Gestational diabetes mellitus. Saudi Med J. 2015;36(4):399–406.
• 22.   Ainuddin JA, Karim N, Zaheer S, et al. Metformin treatment in Type 2 diabetes in pregnancy: an active controlled, parallel-group, randomized, open label study in patients with Type 2 diabetes in pregnancy. J Diabetes Res. 2015;2015:325851.
• 23.   Othman EM, Oli RG, Arias-Loza PA, et al. Metformin protects kidney cells from insulin-mediated genotoxicity in vitro and in male Zucker diabetic fatty rats. Endocrinology. 2016;157(2):548–59