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Elevated adiposity in first trimester increases dysglycemia risk later in pregnancy
The risk for dysglycemia later in pregnancy can be predicted by elevated visceral adipose tissue and total adipose tissue depth in the first trimester, according to recent study findings published in Diabetes Care.
“The associations were independent of maternal age, parity, ethnicity, family, history or type 2 [diabetes] and BMI,” the researchers wrote.
Joel G. Ray, MSc, MD, of St. Michael’s Hospital in Toronto, and colleagues evaluated 485 pregnant women to determine the relationship between first-trimester abdominal adiposity and dysglycemia and gestational diabetes in midpregnancy.
Researchers used ultrasound at 11 to 14 weeks of gestation to measure subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT) and total adipose tissue (TAT) depth.
Fifty-two women developed composite gestational diabetes, impaired fasting glucose or gestational impaired glucose tolerance, and 45 of those met the traditional criteria for gestational diabetes. There was a higher risk for the composite outcome found with the highest quartile of SAT compared with the bottom quartile (unadjusted OR = 3.4; 95% CI, 1.5-8.3); this association was no longer found after adjustment for the covariates (adjusted OR = 1.8; 95% CI, 0.7-4.8). The composite outcome was associated with both the highest quartile of VAT depth (adjusted OR = 3.1; 95% CI, 1.1-9.5) and TAT depth (adjusted OR = 2.7; 95% CI, 1.1-7.8). The same was found for gestational diabetes for the highest quartiles of VAT (adjusted OR = 4.2; 95% CI, 1.4-14.2) and TAT (adjusted OR = 3; 95% CI, 1.1-8.9).
“Our proposed screening approach uses a practical and validated ultrasound-based first-trimester screening tool,” the researchers wrote. “Using this tool and identifying women with high VAT or TAT might enable a practitioner to mitigate the onset of [gestational diabetes] through the upstream management of risk factors. This approach can be compared with our current downstream approach of screening and treating [gestational diabetes] in the second trimester of pregnancy.” – by Amber Cox
Disclosure: Ray reports being supported by an Applied Research Chair in Reproductive and Child Health Services and Policy Research from the Canadian Institutes of Health Research.