Ultrasound markers for prediction of gestational diabetes mellitus in early pregnancy in Egyptian women: observational study

Introduction: Excess visceral adipose tissue (VAT) is associated with insulin resistance in early pregnancy and VAT measurement better explains the association between obesity and insulin resistance than the body mass index. First trimester homeostatic model assessment of insulin resistance (HOMA-IR) or the insulin sensitivity index proved to have positive correlation with late development of gestational diabetes mellitus (GDM) in late pregnancy. Greater VAT depth in the first trimester of pregnancy will be associated with hyperglycemia at 24-28 weeks' gestation. Objectives: To study the relationship between abdominal visceral adiposity and insulin resistance in early pregnancy as a predictor for development of GDM in late pregnancy. Patients and methods: This prospective cohort study included 83 pregnant women at 11-14-week gestation subjected to abdominal adiposity measurement through VAT and subcutaneous adipose tissue (SAT) measurements, then at 16-22 completed a two-hour 75 g OGTT and fasting one-hour and two-hour serum insulin concentration. The HOMA-IR and insulin resistance index (IRI) were calculated. Patients were divided into two groups: group I: pregnant women who did not developed GDM; group 2: pregnant women who developed GDM. Results: Significant statistical difference in both groups as regarding VAT (p = .001). With mean +/- S.D. of VAT increase in Group 2. Mean +/- S.D. of HOMA-IR increase in group 2 with significant statistical difference in both groups (p =.001). Also mean +/- S.D. of ISI increase in group 2 with significant statistical difference in both groups (p = .001). There was positive relationship between visceral adiposity and HOMA-IR and negative relationship between visceral adiposity and insulin sensitivity. Also, in this study, there was no significant relation between SAT and HOMA-IR. Conclusions: From our study, we concluded that measurement of VAT during a routine 11-14 weeks' gestation ultrasound might improve the performance of screening for GDM and correlates with metabolic risk factors even better than BMI.