Department of Obstetrics and Gynecology, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea.
Department of Obstetrics and Gynecology, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea; Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea.
Eur J Obstet Gynecol Reprod Biol. 2024 Nov;302:325-331. doi: 10.1016/j.ejogrb.2024.09.024. Epub 2024 Sep 23.
This study aimed to determine whether fetal subcutaneous tissue (SCT) thickness, measured using ultrasound immediately before and after delivery, can reflect changes in glucose metabolism immediately after delivery. We also evaluated the impact of insulin resistance changes during pregnancy by comparing pregnant women with well-controlled gestational diabetes mellitus (GDM) and those with normal glucose metabolism.
The study participants were 117 pregnant women, including 97 controls and 20 patients with GDM who visited our obstetric clinic between February and December 2022. The participants were scheduled for cesarean delivery at a gestational age of ≥37 weeks. SCT thickness before delivery was measured using ultrasound and within 48 h after delivery using Holtain calipers. The glucose and insulin concentrations were quantified from cord blood collected immediately after delivery. Based on these results, a Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was performed to assess insulin resistance. Independent t-test or Wilcoxon rank-sum test for continuous variables and Fisher's exact test for categorical variables were used to compare the various parameters. Correlations among the variables in each group were assessed by calculating the correlation coefficient (Pearson's correlation).
SCT thickness measured using ultrasound and calipers demonstrated a strong correlation where pregnant women with GDM exhibited thicker fetal SCT and neonate skinfolds than in those without GDM. Glucose and insulin levels in the cord blood were significantly elevated (p < 0.05) in the gestational diabetic group, along with remarkable differences (p < 0.001) in HOMA-IR. These variables indicated a higher prevalence of glucose intolerance in the neonates of mothers with GDM. In pregnant women with GDM, there was a statistically significant correlation between fetal abdominal SCT thickness and glucose levels (r = 0.64, p < 0.01) and HOMA-IR (r = 0.48, p < 0.05).
Measuring the subcutaneous fat thickness of the fetus shortly before delivery is beneficial for predicting insulin resistance in neonates. This is considered particularly useful for women with effectively managed GDM, where the presence of conditions such as macrosomia may not be pronounced.
本研究旨在确定胎儿皮下组织（SCT）厚度是否能反映分娩后即刻的葡萄糖代谢变化，其通过超声在分娩前后即刻测量。我们还通过比较血糖控制良好的妊娠期糖尿病（GDM）孕妇和血糖代谢正常的孕妇，评估了妊娠期间胰岛素抵抗变化的影响。
研究对象为 117 名孕妇，包括 97 名对照组和 20 名 2022 年 2 月至 12 月期间在我们产科门诊就诊的 GDM 患者。这些孕妇计划在妊娠 37 周及以上时行剖宫产术。分娩前使用超声测量 SCT 厚度，分娩后 48 小时内使用 Holtain 卡尺测量。立即从分娩后的脐血中定量检测血糖和胰岛素浓度。根据这些结果，进行稳态模型评估胰岛素抵抗（HOMA-IR）以评估胰岛素抵抗。连续变量采用独立样本 t 检验或 Wilcoxon 秩和检验，分类变量采用 Fisher 确切检验进行比较。每组变量之间的相关性通过计算相关系数（Pearson 相关系数）进行评估。
超声和卡尺测量的 SCT 厚度之间存在很强的相关性，GDM 孕妇的胎儿 SCT 和新生儿皮褶厚度均大于无 GDM 孕妇。GDM 组的脐血葡萄糖和胰岛素水平显著升高（p<0.05），HOMA-IR 差异显著（p<0.001）。这些变量表明 GDM 母亲的新生儿葡萄糖耐量受损更为普遍。GDM 孕妇胎儿腹部 SCT 厚度与血糖水平（r=0.64，p<0.01）和 HOMA-IR（r=0.48，p<0.05）呈统计学显著相关。
分娩前短时间内测量胎儿皮下脂肪厚度有助于预测新生儿的胰岛素抵抗。对于血糖控制良好的 GDM 妇女，特别是对于可能没有明显巨大儿等情况的妇女，这可能特别有用。
