| Background and objective: Gestational diabetes mellitus(GDM)is one of the most common pregnancy complications in the world.With the development of social economy and the improvement of living standard,the prevalence of overweight/obesity is rising.In recent years,with the implementation of the "two-child" policy,more women are getting pregnant at an older age,there has been an increase trend in the prevalence of GDM in China.Studies showed that GDM increased the risk of adverse events such as pregnancy hypertension,giant infants,cesarean section and so on.In addition,it can also increase risk of pregnant women with type2 diabetes and obesity in offspring.At present,GDM is mainly diagnosed by 75 g oral glucose tolerance test(OGTT)at 24-28 weeks of gestation.However,the time for effective intervention and treatment is limited when GDM is diagnosed at this time.Therefore,a specific predictive index for early screening and diagnosis of GDM is needed.As an important risk factor of GDM,obesity plays a role in the development of GDM.Because the effectiveness of obesity defined by body mass index(BMI),waist circumference(WC)and so on in GDM prediction is still controversial,and a small number of studies at home and abroad have found that the accuracy of visceral adipose thickness(VAT)in predicting GDM is better than BMI and other anthropometric parameters,but there is still lack of sufficient evidence.Therefore,we conducted a prospective cohort study with the following main objectives:(1)To clarify the incidence rate of GDM in pregnant women in Qingdao;(2)To explore the relationship between visceral adipose thickness in early pregnancy and the occurrence of GDM,and to clarify the predictive value of visceral adipose thickness for the occurrence of GDM,so as to provide a new scientific basis for the early screening of GDM;(3)To analyze and compare the influence of age and parity of pregnancy on visceral adipose thickness in predicting GDM.Methods: The study is a prospective cohort study.Taking pregnant women of 12-14 weeks gestation in Qingdao Women and Children’s Hospital from May 2019 to September 2020 as the research subjects,the demographic and sociological data,pregnancy and childbirth history,behavior and lifestyle and other related information of the research subjects were collected by way of face-to-face,and the physical indicators such as height,weight,blood pressure and visceral adipose thickness of the survey subjects was measured,as well as biochemical indicators such as blood glucose and blood fat were collected.The result of 75 g OGTT at 24-28 weeks of gestation were followed up,the subjects were divided into GDM group and non-GDM group,and basic characteristics of the two groups were compared.Spearman correlation analysis was used to explore the correlation between visceral adipose thickness and fasting blood glucose,1 hour blood glucose and 2 hours blood glucose.Multivariate logistic regression was used to analyze the influence of visceral adipose thickness and other anthropometric parameters on GDM,the odds ratio(OR)and 95% confidence interval(CI)of each factor were calculated.Receiver operating characteristic curve(ROC)was used to analyze the influence of anthropometric parameters on GDM and area under curve(AUC),sensitivity,specificity,Youden index and optimal cut-off value were also calculated.And we analyze and compare the influence of age and parity of pregnancy and childbirth on the value of VAT in predicting GDM.Results: A total of 1232 pregnant women were included in this study,of which 247 were diagnosed with GDM and the incidence rate of GDM was 20.05%.After adjusting for age,education level,GDM disease history,family history of diabetes,polycystic ovary syndrome disease history,hypertension disease history and physical activity level,multivariate logistic regression analysis showed that compared with the lowest quartile(VAT≤21.70 mm),the third quartile(25.21 mm≤VAT≤29.63 mm)and the fourth quartile(VAT>29.63 mm)were risk factors for GDM.The risk of GDM in the highest quartile was 3.68 times higher than that in the first quartile(OR=3.68,95%CI: 1.59-8.52)and the risk of GDM in the third quartile was2.30 times higher than that in the first quartile(OR=2.30,95%CI: 1.19-5.42).ROC curve analysis showed that the sensitivity,specificity,AUC,Youden index and optimal cut-off value of visceral adipose thickness in early pregnancy were 71.30%,67.90%,0.72(95% CI: 0.68-0.75),0.39 and 26.74 mm,respectively.And the predictive value of visceral adipose thickness for GDM was higher than that of pre-pregnancy BMI,BMI,WC,waist hip ratio,waist to height ratio and weight gain in early pregnancy.However,the AUC of combined factors(visceral adipose thickness combined with age,GDM disease history,family history of diabetes mellitus and BMI in early pregnancy)can reach 0.76,it is more valuable to predict GDM than visceral adipose thickness.Stratified analysis showed that visceral adipose thickness was better than other anthropometric parameters in predicting GDM when the age was less than 35 years old and pregnant women were primipara or multipara.Conclusion: The incidence rate of GDM in pregnant women in Qingdao is higher than that in the national GDM.High visceral adipose thickness in early pregnancy is an independent risk factor for GDM,which has a certain predictive value for GDM.Visceral adipose thickness combined with BMI,age,family history of diabetes mellitus and GDM disease history in early pregnancy has better predictive value for GDM than visceral adipose thickness,which will provide a new scientific basis for the early detection of GDM. |
