Epicardial adipose tissue thickness as a predictor of gestational diabetes mellitus: a prospective cohort study

Background Gestational diabetes mellitus (GDM), the most common metabolic disorder of pregnancy, is a long term risk of comorbidities for maternal and neonatal. The study aimed to assess the association between the echocardiographic epicardial adipose tissue (EAT) and the risk for gestational diabetes mellitus (GDM) in the early second trimester. Methods Singleton pregnancies were enrolled in this study between September 2017 and January 2019 during their 16–20 gestational week. Odds ratio (OR) and 95% confidence intervals (CIs) of individual maternal factors as potential predictors for GDM were calculated using generalized linear models. The receiver-operating-characteristic (ROC) analysis was conducted to assess the discriminative capacity of any individual maternal factor in predicting GDM. Results 69 GDM and 420 normal women were included in the main analysis. Multivariate regression analysis revealed that EAT thickness (OR = 1.96, 95%CI: 1.50–2.55) and high-density lipoprotein cholesterol (OR = 0.21, 95%CI: 0.05–0.84) were associated with the presence of GDM ( P < 0.05). Meanwhile, EAT thickness was associated with adverse outcomes (including large for gestational age, neonatal hypoglycemia, admission to neonatal intensive care unit, preterm delivery, and hyperbilirubinemia) in the GDM group ( P < 0.05). ROC analysis revealed that the area under curve was 0.698 and the cutoff value is 6.77mm only using EAT thickness. After added high-density lipoprotein cholesterol into the analysis, the area under curve was increase into 0.713. Conclusions Echocardiographic EAT thickness is positively and significantly associated with GDM risk and adverse outcomes related to GDM. Echocardiographic EAT is a simple method to predict the development of GDM prior to actual clinical diagnosis. This method provides a new early window of opportunity to implement primary prevention strategies to prevent GDM and reduce the related adverse maternal and perinatal outcomes.