Maternal Visceral Adipose Tissue as a Predictor of Gestational Diabetes Mellitus

Abstract

Background: Gestational Diabetes Mellitus (GDM) is a significant health concern during pregnancy, affecting both maternal and fetal outcomes. Timely identification of women at high risk for GDM is critically important for promptly initiating interventions. This study investigates the potential of first-trimester visceral adipose tissue (VAT) thickness, measured via ultrasound, as a predictor for GDM.
Methodology: This hospital-based prospective cohort study was conducted at Mahatma Gandhi Medical College and Research Institute, Pondicherry. A total of 212 pregnant women attending the antenatal outpatient department for their nuchal translucency (NT) scan at 11-14 weeks of gestation, between December 2022 and February 2024, were enrolled. Pre pregnancy BMI was calculated based on self –reported pre pregnancy weight (kg) or retrieved from medical charts. VAT and SAT (Subcutaneous Adipose Tissue thickness) was measured at the time of ultrasound scan. Women were followed up till delivery. Association of SAT and VAT measurements as a predictor of GDM was determined using multiple regression analysis and ROC analysis was used to determine the cutoff value of SAT, VAT for prediction of GDM.
Results: The prevalence of GDM among the antenatal women was 17.5%. Management of GDM included diet and medical nutrition therapy (10.81%), oral hypoglycemic agents (43.24%), insulin (37.83%), and a combination of both (8.10%). There was no significant difference in age or obstetric score between the GDM and non-GDM groups. However a higher prevalence of GDM was observed in the well-educated group (p=0.025). Significant differences were also noted in SAT, VAT, and total adipose tissue (TAT) measurements, with higher values in the GDM group. VAT and TAT demonstrated strong predictive validity for GDM, as indicated by high AUC values and significant p-values (both <0.001). The GDM group had higher mean newborn weights (p<0.001), although differences in APGAR scores at 1 and 5 minutes were not statistically significant.
Conclusion: Measuring visceral adipose tissue via ultrasound in early pregnancy shows promise as an effective predictor of gestational diabetes mellitus. Incorporating VAT measurement into routine early pregnancy screening could facilitate early interventions, potentially improving outcomes for both mothers and their infants.