First-Trimester Abdominal Adipose Tissue Thickness to Predict Gestational Diabetes

Bourdages, M.; Demers, Marie‐Elaine; Dubé, Samuel; Gasse, Cédric; Girard, M. Fusco; Boutin, Amélie; Ray, Joel G.; Bujold, Emmanuel; Demers, Suzanne

doi:10.1016/j.jogc.2017.09.026

Cited by 32 publications

(41 citation statements)

References 14 publications

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“…www.nature.com/scientificreports www.nature.com/scientificreports/ In a cohort of 1048 pregnant women, Bourdages et al 10 observed that first-trimester VAD was associated with a higher likelihood of developing GDM. They also reported a marginal improvement in GDM prediction using VAD, over using BMI alone.…”

Section: Discussionmentioning

confidence: 99%

Visceral Adipose Tissue Depth in Early Pregnancy and Gestational Diabetes Mellitus - a Cohort Study

Alves

Souza

Figueirôa

et al. 2020

Sci Rep

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Some studies have suggested that abdominal visceral adipose tissue depth (VAD) measured by ultrasound in early pregnancy, may predict the future onset of gestational diabetes mellitus (GDM). Wheter this is true, independent of pre-pregnancy body mass index (BMi), has been debated, leading the current study. A prospective cohort study was completed, in which VAD was measured at around 14 weeks' gestation. GDM was later assessed by an oral glucose tolerance test at 24 to 28 weeks, according to the iADpSG criteria. Logistic regression analysis and receiver operating curve (Roc) analysis were used to estimate the predictive value of VAD, above and beyond pre-pregnancy BMI. 627 pregnant women were enrolled, and 518 completed the study. VAD was measured at a mean of 14.4 weeks' gestation. 87 women (16.8%) subsequently developed GDM. The unadjusted odds ratio (OR) for developing GDM was 1.99 (95% CI 1.59-2.46) per 1-cm increase in VAD. After adjusting for maternal BMI and age, the OR was 2.00 (95% CI 1.61 to 2.50). The ROC under the curve for developing GDM was higher for VAD (0.70, 95% CI 0.63 to 0.75) than for pre-pregnancy BMI (0.57 95% CI 0.50 to 0.64) (p < 0.001). In conclusion, higher VAD may better predict GDM than pre-pregnancy BMi. Gestational diabetes mellitus (GDM)-glucose intolerance, resulting in new onset in pregnancy-has emerged as a global public health concern 1. GDM is associated with potentially harmful health effects for mother and fetus 2. According to the World Health Organization (WHO), the prevalence of GDM is rising 3 , largely attributed to the worldwide epidemic of obesity, older maternal age at first pregnancy, and a change in the diagnostic criteria for GDM 4. Currently, the International Association of Diabetes recommends screening for GDM among all pregnant women, at 24 to 28 weeks' gestation, using a 75-g oral glucose tolerance test (OGTT) 5. AS this approach lacks a sufficient sensitivity and specificity 6 , a method that may improve the detection of GDM, earlier pregnancy, is desirable. Some studies have shown that abdominal visceral adipose tissue depth (VAD) measured by ultrasound in earlier pregnancy, may predict glucose intolerance, insulin resistance, metabolic syndrome, newborn weight and GDM later in pregnancy 7-13. Recently, Thaware et al. 14 showed that ultrasonography-measured VAD in early pregnancy aided in the early recognition of GDM. They reported that this method, compared with an OGTT alone, could reduce by half number of pregnant women requiring OGTT screening. However, it is not clear whether ultrasonography-measured VAD offers improve discrimination in the detection of GDM compared with simply using pre-pregnancy body mass index (BMI). Herein, we carried out a prospective cohort study among a large sample of pregnant women, to assess the role of VAD in the prediction of GDM. Methods Design and study participants. This was a prospective cohort study of pregnant women, followed from

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Section: Discussionmentioning

confidence: 99%

Visceral Adipose Tissue Depth in Early Pregnancy and Gestational Diabetes Mellitus - a Cohort Study

Alves

Souza

Figueirôa

et al. 2020

Sci Rep

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“…In this group of patients, GDM is rarely diagnosed or even suspected until the second trimester, which may result in prolonged and elevated levels of maternal blood glucose in early pregnancy (especially in the postprandial period). Previous studies [7,10,[17][18][19] have assessed the use of ultrasound aiming GDM early screening, but, to our knowledge, this is the first to focus on non-obese patients, in a low-risk outpatient environment, and compare VAT findings with gestational outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The pathophysiology of central fat-related diseases involves three mechanisms: 1) the release of large amounts of free fatty acid in the liver, initiating decompensation with hyperinsulinemia, dyslipidemia and hyperglycemia; 2) visceral adipocytes capable of releasing visfatin, a cytokine related to diabetes and PLOS ONE cardiovascular disease; and 3) visceral adiposity associated with the hypothalamus-pituitaryadrenal axis, leading to sympathetic overactivity [7]. Maternal visceral fat composition, as quantified by ultrasonography, has been associated with altered fasting glucose [8] [9], altered glucose tolerance test [10], pre-eclampsia [11], and preterm delivery [11]. Nevertheless, all of these studies evaluated non-obese, overweight and obese patients as a single group.…”

Section: Introductionmentioning

confidence: 99%

Maternal visceral adipose tissue during the first half of pregnancy predicts gestational diabetes at the time of delivery – a cohort study

et al. 2020

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Background Gestational diabetes mellitus (GDM) is a common condition, often associated with high maternal and fetal morbidity. The use of new tools for early GDM screening can contribute to metabolic control to reduce maternal and fetal risk. This study aimed to ascertain whether maternal visceral adipose tissue (VAT) measurement by ultrasound during the first half of pregnancy can predict the occurrence of GDM during the third trimester. Methods A prospective cohort study of 133 pregnant women with gestational age �20 weeks in an outpatient setting. VAT depth was measured by ultrasound at the maternal periumbilical region. GDM status was obtained through hospital charts during hospitalization to delivery. A Receiver Operator Characteristic (ROC) curve was used to determine the optimum threshold to predict GDM. Results According to the ROC curve, a 45mm threshold was identified as the best cutoff value, with 66% of accuracy to predict GDM. Crude and adjusted odds ratios (OR) for GDM were 13.4 (95%CI 2.9-61.1) and 8.9 (95%CI 1.9-42.2), respectively. A similar result was obtained among pre-gravid non-obese women, with crude and adjusted OR of 16.6 (95%CI 1.9-PLOS ONE

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“…However, this index is limited with regard to the differentiation of adipose content (1), particularly in the central region, the focus of the present study. Furthermore, despite the ease of measuring BMI, it has low predictive precision for abnormal pregnancy results; therefore, new diagnostic modalities can improve these scores, as demonstrated by Bourdages et al (2018) and Souza et al (2016), where the increase in visceral adipose tissue, identi ed during the rst trimester, was associated with a greater chance of developing gestational diabetes mellitus (9,19).…”

Section: Discussionmentioning

confidence: 99%

Anthropometrical measurements and maternal visceral fat during first half of pregnancy: a cross-sectional survey

Kretzer

Matos

Diemen

et al. 2020

Preprint

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Background Determining anthropometric measures that indicate different fat deposits can be useful to predict metabolic risk and set specific treatment goals, reducing negative consequences for maternal and fetal health. In cases where pre-gestational weight measure and subsequent body mass index (BMI) values cannot be determined, other anthropometric measurements may be ideal for measuring the nutritional status of pregnant women, especially in low- and middle-income countries. This study aims to identify which anthropometric measurements correlate better with the maternal fat deposits measured by ultrasound. Methods A cross-sectional study was conducted with pregnant women from the city of Porto Alegre (city), capital of Rio Grande do Sul (state), southern Brazil, from October 2016 until January 2018. Anthropometrical variables (weight, height, mid-upper arm circumference [MUAC], circumferences of calf and neck and triceps skinfolds [TSF] and subscapular skinfolds [SBSF]), and ultrasound variables (visceral adipose tissue [VAT] and total adipose tissue [TAT]) were collected. To verify the correlation of anthropometric and ultrasound measurements, a non-adjusted and adjusted Spearman correlation was used. The study was approved by the ethics committees. Results The age median of the 149 pregnant women was 25 years [21 - 31], pre-pregnancy BMI was 26.22kg/m² [22.16 – 31.21] and gestational age was 16.2 weeks [13.05 – 18.10]. The best measurements correlated with VAT and TAT were MUAC and SBSF, both of which showed a higher correlation than pre-pregnancy BMI. Conclusion It is possible to provide a practical and reliable estimate of VAT and TAT from the anthropometric evaluation (MUAC or SBSF) that is low cost, efficient and replicable in an outpatient clinic environment, especially in low- and middle-income countries.

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First-Trimester Abdominal Adipose Tissue Thickness to Predict Gestational Diabetes

Cited by 32 publications

References 14 publications

Visceral Adipose Tissue Depth in Early Pregnancy and Gestational Diabetes Mellitus - a Cohort Study

Visceral Adipose Tissue Depth in Early Pregnancy and Gestational Diabetes Mellitus - a Cohort Study

Maternal visceral adipose tissue during the first half of pregnancy predicts gestational diabetes at the time of delivery – a cohort study

Anthropometrical measurements and maternal visceral fat during first half of pregnancy: a cross-sectional survey

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