medwireNews: Visceral adipose tissue depth (VAD) measured during the first trimester of pregnancy predicts gestational diabetes better than current clinical indicators, research suggests.
The technique had a positive predictive value (PPV) of 41.3% when tested in 123 pregnant women with clinical risk factors for gestational diabetes.
Presenting the findings at the virtual 2021 Diabetes UK Professional Conference, Robert D’Arcy (Royal Victoria Hospital, Belfast, UK) said the PPV for VAD measurement was around twice that of the clinical predictors recommended by the UK’s National Institute for Health and Care Excellence.
All women in the study had one or more risk factors, namely BMI of 30 kg/m2 or greater, family history of diabetes, high-risk ethnicity, or a previous macrosomic infant. Those with previous gestational diabetes or elevated glycated hemoglobin levels were excluded.
Most women were recruited on the basis of high BMI; however, D’Arcy pointed out that BMI correlated poorly with visceral adipose tissue, which is known to have an adverse effect on cardiometabolic risk, whereas subcutaneous fat is relatively benign.
Direct measurement of body fat using ultrasound found no relationship between subcutaneous fat and gestational diabetes risk, but VAD, at a cutoff of 3.98 cm, was 73.1% sensitive and 72.2% specific for a later gestational diabetes diagnosis, assessed by oral glucose tolerance test early in the third trimester.
Average VAD was 4.22 cm in women who went on to develop gestational diabetes and 3.12 cm in those who did not.
D’Arcy stressed the simplicity of the technique. “I envisage that if this translates into clinical practice it would be performed by midwives” at the time of the first routine scan, he said, adding that those midwives who had learned the technique during the study had found it straightforward.
However, he cautioned that a larger study is needed before VAD measurement can be used to predict gestational diabetes in clinical practice.
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