The Value Of Maternal Upper Abdominal Adipose Thickness In Predicting Gestational Diabetes Mellitus In Early Pregnancy

Objective:Ultrasound was used to measure maternal upper abdominal adipose thickness in early pregnancy.To study the effect of maternal upper abdominal adipose thickness in early pregnancy on the occurrence of gestational diabetes mellitus（GDM）and to explore the value of maternal upper abdominal adipose thickness in predicting GDM in early pregnancy.Methods:This study adopted prospective analysis method.The singleton 11-13W⁺⁶pregnant women who were registered in the Second Affiliated Hospital of Weihai City of Qingdao University for prenatal examination from May 2021 to October 2022 were selected,without Diabetes Mellitus and other complications and endocrine diseases.After using the C5-1 probe of Philips i U22 ultrasound diagnostic instrument for routine screening of nuchal translucence of the fetus,we replaced the L12-5 probe and measured the upper abdominal adipose thickness under the xiphoid of the pregnant women,including subcutaneous adipose thickness（SAT）and visceral adipose thickness（VAT）.SAT was the distance from the inner edge of the skin to the anterior edge of the abdominal linea alba,and VAT was the distance from the posterior edge of the abdominal linea alba to the anterior edge of the left lobe of the liver.All the pregnant women filled in the questionnaires,which recorded the age,height,weight,weight before pregnancy,weight gained,number of pregnancies,family history of diabetes and other basic information of pregnant women.Body mass index（BMI）and BMI before pregnancy were calculated.We followed up the results of oral glucose tolerance test（OGTT）of all the pregnant women during 24W to 28W,and all the pregnant women were divided into two groups,the GDM group and the control group according to the OGTT results.To compare and analyze the basic information and adipose thickness of the two groups.Spearman correlation analysis was conducted between the adipose thickness and other common measurement indicators of all pregnant women and the occurrence of GDM.Single factor and multivariate factors logistic regression analysis were used to analyse the influencing factors of GDM.The odds ratio（OR）and 95%confidence interval（CI）of every influencing factor were calculated.The ROC curve was used to calculate area under curve（AUC）and optimal cut-off value,sensitivity,specificity,to estimate the value of SAT and VAT in predicting GDM.To compare the ability of SAT and VAT in predicting GDM with other common measurement indicators such as weight and BMI.Further,all the pregnant women were grouped according to age and BMI,and divided into the elderly group and the non-elderly group,the overweight group and the non-overweight group,to evaluate the value of SAT and VAT in predicting GDM.Results:There were a total of 1162 pregnant women involved into this study,which included1000 in the control group and 162 in the GDM group.The age,weight,BMI,weight before pregnancy,BMI before pregnancy,weight gained in early pregnancy,SAT and VAT of the GDM group were higher than those of the control group,and the height of the GDM group was lower than that of the control group.The difference was statistically significant（P<0.05）.Spearman correlation analysis showed that compared with weight,BMI,weight before pregnancy,and BMI before pregnancy,SAT and VAT had the strongest correlation with GDM,with correlation coefficients of 0.309 and 0.264（P<0.05）,respectively.Single factor logistic regression analysis showed that age,weight,weight before pregnancy,BMI,BMI before pregnancy,SAT and VAT were risk factors of GDM.OR and 95%CI of SAT and VAT were 1.201（95%CI 1.161-1.242）and1.178（95%CI 1.137-1.221）,respectively.Multivariate factors logistic regression analysis showed that SAT and VAT were independent risk factors of GDM.OR and 95%CI of SAT and VAT were 1.170（95%CI 1.122-1.220）and 1.137（95%CI 1.088-1.188）,respectively.The ROC curve analysis showed that AUC of SAT and VAT in predicting GDM were0.758 and 0.720,respectively.The optimal cut-off value of SAT was 18.475mm,the sensitivity in predicting GDM was 60.5%,and the specificity was 70.9%.The optimal cut-off value of VAT was 16.625mm,the sensitivity in predicting GDM was 71.6%,and the specificity was 64.6%.The AUC of SAT and VAT combined to predict GDM was0.776,the sensitivity corresponding to the maximum Yoden index was 66%,and the specificity was 74.2%.After further analysis according to age and BMI subgroup,SAT and VAT had greater predictive value in non-elderly and non-overweight pregnant women compared with elderly and overweight pregnant women.The AUC of SAT and VAT in predicting GDM in non-elderly pregnant women were 0.764 and 0.727,respectively.The AUC of SAT and VAT in predicting GDM in elderly pregnant women were 0.740 and0.688,respectively.The AUC of SAT and VAT in predicting GDM in non-overweight pregnant women were 0.772 and 0.713,respectively.The AUC of SAT and VAT in predicting GDM in overweight pregnant women were 0.640 and 0.634,respectively.Conclusions:1.The maternal upper abdominal adipose thickness in early pregnancy are independent risk factors of GDM.2.The maternal upper abdominal adipose thickness in early pregnancy has certain clinical significance in predicting the diagnosis of GDM.The ability of SAT and VAT in early pregnancy in predicting GDM is superior to other common measurement indicators such as body weight and BMI.3.The maternal upper abdominal SAT and VAT in early pregnancy have higher value in predicting GDM in the non-elderly group and non-overweight pregnant women.