Abstract
Aims/hypothesisGestational diabetes mellitus (GDM) is associated with an increased future risk of obesity in the offspring. Increased adiposity has been observed in the newborns of women with GDM. Our aim was to examine early fetal adiposity in women with GDM.MethodsObstetric and sonographic data was collated for 153 women with GDM and 178 controls from a single centre in Chennai, India. Fetal head circumference (HC), abdominal circumference (AC), femur length (FL) and biparietal diameter (BPD) were recorded at 11, 20 and 32 weeks. Anterior abdominal wall thickness (AAWT) as a marker of abdominal adiposity at 20 and 32 weeks was compared between groups. Adjustments were made for maternal age, BMI, parity, gestational weight gain, fetal sex and gestational age.ResultsFetuses of women with GDM had significantly higher AAWT at 20 weeks (β 0.26 [95% CI 0.15, 0.37] mm, p < 0.0001) despite lower measures of HC, FL, BPD and AC. AAWT remained higher in the fetuses of women with GDM at 32 weeks (β 0.48 [0.30, 0.65] mm, p < 0.0001) despite similar measures for HC, FL, BPD and AC between groups. Both groups had similar birthweights at term. There was an independent relationship between fasting plasma glucose levels and AAWT after adjustment as described above.Conclusions/interpretationA ‘thin but fat’ phenotype signifying a disproportionate increase in adiposity despite smaller or similar lean body mass was observed in the fetuses of mothers with GDM, even at 20 weeks, thus pre-dating the biochemical diagnosis of GDM. Increased AAWT may serve as an early marker of GDM.
Highlights
Gestational diabetes mellitus (GDM) is associated with several maternal and neonatal complications [1]
There was an independent relationship between fasting plasma glucose levels and abdominal wall thickness (AAWT) after adjustment as described above
Our results provide novel evidence that higher fetal adiposity is associated with GDM from as early as 20 weeks of gestation, a mean of 4.7 weeks before the biochemical diagnosis of GDM, in a South Asian population
Summary
Gestational diabetes mellitus (GDM) is associated with several maternal and neonatal complications [1]. The offspring of mothers with GDM have a two- to fourfold higher future risk of obesity and diabetes [4,5,6], with evidence for increased BMI, body fat and subcutaneous abdominal fat in early childhood and adolescence [7,8,9]. There is emerging evidence that this increase in adiposity in the offspring of women with GDM begins in early fetal life [10, 11]. Such fetuses exhibit a ‘thin–fat’ phenotype i.e. have preferential growth of insulin sensitive adipose tissue mass over that of fat-free lean tissues [10], with a higher total fat:lean mass ratio [12]. Current evidence for a link between increased fetal adiposity and GDM is restricted to late pregnancy [11,12,13,14] and birth [10, 15, 16] (electronic supplementary material [ESM] Table 1)
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