Fetal epicardial fat thickness: Can it serve as a sonographic screening marker for gestational diabetes mellitus?

Abstract

Background: Gestational diabetes mellitus (GDM) is defined as the new onset of impairment in carbohydrate tolerance during pregnancy. The aim of the current study was to define fetal epicardial fat thickness (fEFT) changes that developed before 24 weeks of gestation, to evaluate the diagnostic effectiveness of fEFT in predicting GDM diagnosis, and to correlate fEFT values with hemoglobin A1C (HbA1C) values. Methods: The study included a total of 60 GDM patients and 60 control subjects. A record consisted of fEFT measurements, maternal body mass index, maternal subcutaneous fat thickness, and fetal subcutaneous fat thickness during sonographic screening performed at 18–22 gestational weeks. Fetal abdominal circumference (AC) values, estimated fetal weight (EFW), and fetal gender were also recorded. Results: The median fEFT measurement of the whole study population was 0.9 ± 0.21 mm; 1.05 ± 0.21 mm in the GDM patients, and 0.8 ± 0.15 mm in the control group. The median fEFT values of the GDM patients were significantly higher than those of the control group ( P < 0.01). According to the correlation analysis results, a strong positive correlation was determined between the fEFT and HbA1C values ( r = 0.71, P < 0.01), gestational week of the fetus ( r = 0.76, P = P < 0.01), AC ( r = 0.81, P < 0.01), and EFW ( r = 0.71, P < 0.01). According to the receiver operating characteristic analysis results, a fEFT value of > 0.95 can predict GDM diagnosis with sensitivity of 65% and specificity of 88% (odds ratio = 13). Conclusion: fEFT values are increased in GDM cases, and the increase can be detected earlier than 24 weeks of gestation. fEFT values are positively correlated with HbA1C values and can serve as an early predictor for GDM diagnosis.

Immunoendocrine Dysregulation during Gestational Diabetes Mellitus: The Central Role of the Placenta

“…The fetus absorbs glucose, stores it in the form of glycogen in the liver, and the excess is converted into visceral fat, increasing the fetal abdominal circumference. Moreover, fetal epicardial fat thickness has been proposed as an earlier marker (before 24 weeks) to screen GDM women [ 314 ]. Macrosomia and hyperglycemia predispose to obstetrics complications such as shoulder dystocia at birth, plexus-brachial injury, respiratory distress syndrome, as well as the need for instrumented delivery [ 7 , 315 ].…”

Cardiac changes in infants of diabetic mothers

“…This increase can be detected even at 24 wk of gestation. In addition, foetal EFT values are positively correlated with HbA1c values and can be an early predictor for gestational DM diagnosis[ 46 ].…”

Increased fetal epicardial fat thickness: A reflecting finding for GDM and perinatal outcomes

“…In the other study by Aydın et al fetal EFT measurements were performed at 18-22 weeks of gestation. 25 They showed that the fetal EFT values of GDM patients were significantly higher than those of the control group. Moreover, correlation analysis showed that a strong positive correlation was observed between fetal EFT and Hba1c values and EFW.…”

“…20,21 There are few studies that investigated the measurement of EFT in fetuses of mothers with GDM. [22][23][24][25] The need for markers that can help predict the occurrence of GDM and the increased risk of GDM-related perinatal complications remains one of the main topics of current studies. Because previous studies have shown that the increase in fetal adipose tissue in fetuses with GDM occurs most frequently in the 3rd trimester, we aimed to compare fetal EFT in the 3rd trimester in cases diagnosed with GDM with fetuses from healthy mothers.…”