Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Biostatistics and Bioinformatics Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Diabetes Care. 2024 Dec 1;47(12):2180-2188. doi: 10.2337/dc24-1068.
Gestational diabetes mellitus (GDM) increases the risk of fetal overgrowth as measured by two-dimensional ultrasonography. Whether fetal three-dimensional (3D) soft tissue and organ volumes provide additional insight into fetal overgrowth is unknown.
We prospectively evaluated longitudinal 3D fetal body composition and organ volumes in a diverse U.S. singleton pregnancy cohort (2015-2019). Women were diagnosed with GDM, impaired glucose tolerance (IGT), or normal glucose tolerance (NGT). Up to five 3D ultrasound scans measured fetal body composition and organ volumes; trajectories were modeled using linear mixed models. Overall and weekly mean differences in fetal 3D trajectories were tested across glycemic status, adjusted for covariates.
In this sample (n = 2,427), 5.2% of women had GDM, and 3.0% had IGT. Fetuses of women who developed GDM compared with NGT had larger fractional arm and fractional fat arm volumes from 26 to 35 weeks, smaller fractional lean arm volume from 17 to 22 weeks, and larger abdominal area from 24 to 40 weeks. Fetuses of women with IGT had similar growth patterns, which manifested later in gestation and with larger magnitudes, and had larger fractional lean arm volume. No overall differences were observed among thigh or organ volumes across glycemic status.
Body composition differed in fetuses of GDM-complicated pregnancies, including larger arm and abdominal measures across the second and third trimesters. Patterns were similar in IGT-complicated pregnancies except that they occurred later in gestation and with larger magnitudes. Future research should explore how lifestyle and medication may alter fetal fat accumulation trajectories among hyperglycemic pregnancies.
二维超声检查显示，妊娠期糖尿病（GDM）会增加胎儿过度生长的风险。胎儿三维（3D）软组织和器官体积是否能提供更多关于胎儿过度生长的信息尚不清楚。
我们前瞻性地评估了 2015 年至 2019 年间美国多元化单胎妊娠队列的 3D 胎儿身体成分和器官体积的纵向变化。将孕妇分为 GDM、糖耐量受损（IGT）或正常糖耐量（NGT）组。通过 5 次 3D 超声扫描测量胎儿的身体成分和器官体积；采用线性混合模型对轨迹进行建模。在调整了协变量后，比较了不同血糖状态下胎儿 3D 轨迹的整体和每周平均差异。
在本研究样本（n=2427）中，5.2%的孕妇患有 GDM，3.0%患有 IGT。与 NGT 组相比，患有 GDM 的孕妇的胎儿在 26 至 35 周时手臂和脂肪手臂的分数体积更大，17 至 22 周时瘦手臂的分数体积更小，24 至 40 周时腹部面积更大。IGT 孕妇的胎儿生长模式相似，只是在妊娠晚期表现出来，且幅度更大，瘦手臂的分数体积也更大。在血糖状态下，大腿或器官的体积没有观察到总体差异。
GDM 合并妊娠的胎儿身体成分存在差异，包括在第二和第三孕期手臂和腹部的测量值更大。IGT 合并妊娠的模式相似，只是发生在妊娠晚期，幅度更大。未来的研究应该探讨生活方式和药物治疗如何改变高血糖妊娠中胎儿脂肪积累的轨迹。
