Associations between maternal visceral fat in mid-pregnancy and subsequent gestational diabetes mellitus in a Chinese population: a cohort study

Abstract

Abstract Background Maternal obesity is an established risk factor for gestational diabetes mellitus (GDM). This study aimed to investigate the association between ultrasound-measured visceral adipose tissue and GDM risk in lean Chinese pregnant women. Methods A prospective cohort study of pregnant women aged 18–45 years with a singleton pregnancy was conducted in Shenzhen Nanshan Maternity and Child Healthcare Hospital, China, between May 2022 and October 2022. Ultrasound measurements of abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) depth were performed at 21–23 weeks’ gestation. GDM diagnosis was performed using 75 g oral glucose tolerance test (OGTT) at 24–28 weeks’ gestation. After adjustment for maternal age, parity, family history of diabetes, educational level, and pre-pregnancy body mass index (BMI), log-binomial model was used to analyze the associations of ultrasound measurements of VAT and SAT with GDM. A receiver-operating characteristic (ROC) curve analysis was conducted to assess the predictive value of VAT and SAT for new-onset GDM. Results Among 550 women included, 141 subjects (25.6%) developed GDM. The mean maternal age (32.9 ± 4.8 vs. 30.7 ± 4.2 year, P < 0.001) and the mean pre-pregnancy BMI (22.05 ± 2.95 vs. 20.76 ± 2.46 kg/m2, P < 0.001) were significantly higher in women who developed GDM than those who did not. Ultrasound measurements of VAT depth, but not SAT depth, were significantly associated with increased risk for GDM, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) after adjustment for potential confounders. Compared with the bottom tertile, the risk ratio (RR) and 95% confidence interval (95% CI) in the highest tertile of ultrasound measurements of VAT depth for GDM, IFG and IGT were 2.04 (1.24–3.37), 10.86 (1.37–85.80) and 2.03 (1.22–3.39), respectively. The receiver-operating characteristic (ROC) curve analysis for diagnosis of GDM showed a higher area under the curve (AUC) for VAT than SAT or pre-pregnancy BMI. In stratified analysis, the association of VAT depth with fasting glucose was more profound in women with normal weight before pregnancy than those with overweight or obesity (P - interaction = 0.009). Conclusions Ultrasound-measured abdominal VAT during mid-pregnancy is a potential clinical tool for improving sensitivity of early risk stratification for GDM in non-obese pregnant women.

Keywords

• Gestational diabetes
• Maternal visceral obesity
• Ultrasound
• Chinese pregnant women