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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
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Foundation Awardee
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Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 4

Category: Clinical Obstetrics

Poster Session 4

(1264) Comparison of Gestational Diabetes Treatment Modalities and Associated Placental Histopathology

Thursday, February 12, 2026
3:30 PM - 5:00 PM  
Objective:
The association between GDM treatment and placental histopathology remains unclear. We aimed to describe placental histopathology in patients with gestational diabetes mellitus (GDM) by diet, oral, or insulin treatment modality. 

Study Design:
We conducted a retrospective cohort study of patients with GDM who delivered at a single academic medical center (2019 to 2023) with available placental histopathology for review. Patients were categorized by treatment modality: diet, oral agents (metformin or glyburide), or insulin. Those with multiple gestation, placenta accreta spectrum, or absence of placental pathology were excluded. Placental histopathology reports were abstracted for findings per College of American Pathologists (CAP) guidelines, including placenta weight, maternal and fetal vascular malperfusion (MVM and FVM), and infection/inflammation. Maternal demographics and pregnancy outcomes were assessed. Chi-square and t-tests were used for statistical comparisons. 

Results:
Of 459 patients with GDM and placental histopathology, 49.0% were managed with diet, 5.9% with oral agents, and 45.1% with insulin. Insulin-controlled patients were more likely to be older, have obesity, chronic hypertension, and earlier GDM diagnosis (all p< 0.01). However, no statistically significant differences were observed across treatment groups in placental weight (p=0.22), MVM (p=0.58), FVM (p=0.26), or infection/inflammatory lesions (p=0.34). MVM was common across all groups, with >60% of placentas showing at least one MVM lesion, regardless of treatment modality. Retroplacental hemorrhage was more frequent in the oral group (7.4%, p=0.03) compared to others, but other lesion subtypes were similarly distributed. 

Conclusion:
Placental histopathologic findings did not differ significantly by GDM treatment modality. The high prevalence of MVM across all groups suggests that GDM itself—rather than treatment modality—may be the principal driver of placental changes. These findings reinforce the need for further research into GDM-mediated placental pathology and its implications for maternal and neonatal outcomes.