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Abdominal Fat Early in Pregnancy Predicts Gestational Diabetes

Nov 13, 2015

Higher fat in midsection poses increased risk for gestational diabetes later in pregnancy.

A prospective cohort study published in Diabetes Care suggests that abdominal adiposity is a predictive marker of gestational diabetes mellitus (GDM) appearing later in pregnancy.

The cohort included 485 women. They were assessed for subcutaneous, visceral, and total adipose tissue depth with ultrasound between 11 and 14 weeks of gestation. The pregnant women were all between the ages of 18 and 42 years old for the study. The composite endpoint was impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and full GDM. Glycemic control was assessed with a 75 g oral glucose tolerance test (OGTT) at 24 to 28 weeks of gestation. Logical regression analysis was used to assess the relationship between varying levels of adiposity and the composite outcome.

After adjusting for confounders such as age, ethnicity, BMI, and family history, quartile 4 VAT and TAT vs. quartile 1 VAT and TAT (quartile 4 being more adiposity) were both  significantly associated with gestational diabetes (adjusted odds ratio 3.2, 95% CI 1.1-9.9). This association was not true, however, for SAT (adjusted odds ratio 1.8, 95% CI 0.70-4.8). These correlations were also true for the endpoint of gestational diabetes mellitus alone.

The association between increased VAT and TAT in the first trimester and GDM suggests that abdominal adiposity could be measured early in pregnancy to screen for GDM later in pregnancy. This can allow time for maternal women to delay or prevent onset of GDM, which itself is a risk factor for type 2 diabetes mellitus (T2DM): up to 50% of women with GDM may go on to develop T2DM. More research is necessary to ascertain the exact causal relationship.

Practice Pearls:

  • Increased VAT and TAT in the first trimester of pregnancy are associated with increased risk of GDM.
  • Increased SAT was not associated with a risk of GDM.
  • Abdominal adiposity may be a useful screening tool to detect GDM risk in pregnant women.

De Souza LR, Berger H, Retnakaran R, et al. “First-Trimester Maternal Abdominal Adiposity Predicts Dysglycemia and Gestational Diabetes Mellitus in Midpregnancy”. Diabetes Care. 2015. Published online November 2, 2015. doi: 10.2337/dc15-2027.