Early Prediction of Gestational Diabetes Mellitus Using Placental Strain Elastography and Subcutaneous Adipose Tissue Thickness

Abstract

Aim The aim of this study is to investigate the efficacy of placental strain ratio values measured by real-time sonoelastography and maternal subcutaneous adipose tissue thickness measured by two-dimensional ultrasonography in predicting gestational diabetes mellitus in the first trimester.

Materials and methods The population of the study consisted of the first 210 consecutive singleton pregnant women who applied for routine first-trimester screening between the 11th and 14th week of gestation.B-mode subcutaneous adipose tissue thickness sonography and real-time placental strain elastography scanning were performed.All patients underwent 75 g oral glucose tolerance test between the 24th and 28th week of gestation. American Diabetes Association criteria were used in the diagnosis of gestational diabetes mellitus.

Results It was observed that body mass index (p<0.001), first-trimester fasting blood sugar (p<0.001), subcutaneous adipose tissue thickness (p<0.001), and placental strain ratio value (p<0.001) affected the development of gestational diabetes mellitus statistically. The multivariate analysis shown that subcutaneous adipose tissue thickness (odds ratio=1.271, 95% CI=1.142–1.416, p<0.001) and placental strain ratio value (odds ratio=3.664, 95% CI=1.927–6.969, p<0.001) were the independent risk factors affecting the development of gestational diabetes mellitus.

Conclusions The findings of this study indicated a positive correlation between 75 g oral glucose tolerance test application and first trimester subcutaneous adipose tissue thickness and placental strain ratio. Using the cut-off values of>11.5 mm for subcutaneous adipose tissue and>0.986 for placental strain ratio, the development of gestational diabetes mellitus may be predicted in the early weeks of pregnancy.

Key words

Gestational diabetes mellitus - placental strain elastography - subcutaneous adipose tissue - ultrasonography

• References

• 1 Chiefari E, Arcidiacono B, Foti D. et al. Gestational diabetes mellitus: an updated overview. J Endocrinol Invest 2017; 40: 899-909
• 2 ACOG. Implementation Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol 2018; 131: e49-e64
• 3 Immanuel J, Simmons D. Screening and treatment for early-onset gestational diabetes mellitus: a systematic review and meta-analysis. Curr Diab Rep 2017; 17: 115
• 4 Yan-Ting W, Chen-Jie Z, Mol BW. et al. Early prediction of gestational diabetes mellitus in the Chinese population via advanced machine learning. J Clin Endocrinol Metab 2021; 106: e1191-e1205
• 5 Meng Q, Shao L, Luo X. et al. Ultrastructure of placenta of gravidas with gestational diabetes mellitus. Obstet Gynecol Int 2015; 2015: 283124
• 6 Abdelghany AH, Eissa TM. Study of the ultrastructure of the placenta in gestational diabetes mellitus. Int J Anat Var 2018; 4-10
• 7 Klintworth N, Mantsopoulos K, Zenk J. et al. Sonoelastography of parotid gland tumours: Initial experience and identification of characteristic patterns. Eur Radiol 2012; 22: 947-956
• 8 Barr RG, Nakashima K, Amy D. et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 2: breast. Ultrasound Med Biol 2015; 41: 1148-1160
• 9 Gietka-Czernel M, Kochman M, Bujalska K. et al. Real-time ultrasound elastography – a new tool for diagnosing thyroid nodules. Endokrynol Pol 2010; 61: 652-657
• 10 Altinbas NK, Anamurluoglu EG, Oz II. et al. Real-time sonoelastography of parotid gland tumors. J Ultrasound Med 2017; 36: 77-87
• 11 Sugitani M, Fujita Y, Yumoto Y. et al. A new method for measurement of placental elasticity: acoustic radiation force impulse imaging. Placenta 2013; 34: 1009-1013
• 12 Cimsit C, Yoldemir T, Akpinar IN. Strain elastography in placental dysfunction: placental elasticity differences in normal and preeclamptic pregnancies in the second trimester. Arch Gynecol Obstet 2015; 291: 811-817
• 13 Ertekin E, Tunçyürek Ö, Kafkas S. et al. Does the placental strain ratio correlate with the umbilical artery Doppler values?. Clin Exp Obstet Gynecol 2019; 46: 227-230
• 14 Durhan G, Ünverdi H, Deveci C. et al. Placental elasticity and histopathological findings in normal and intra-uterine growth restriction pregnancies assessed with strain elastography in ex vivo placenta. Ultrasound Med Biol 2017; 43: 111-118
• 15 Saw SN, Low JYR, Mattar CNZ. et al. Motorizing and optimizing ultrasound strain elastography for detection of intrauterine growth restriction pregnancies. Ultrasound Med Biol 2018; 44: 532-543
• 16 Herman BA, Harris GR. Models and regulatory considerations for transient temperature rise during diagnostic ultrasound pulses. Ultrasound Med Biol 2002; 28: 1217-1224
• 17 Sugitani M, Fujita Y, Yumoto Y. et al. A new method for measurement of placental elasticity: acoustic radiation force impulse imaging. Placenta 2013; 34: 1009-1013
• 18 Bourdages M, Demers MÉ, Dubé S. et al. First-trimester abdominal adipose tissue thickness to predict gestational diabetes. J Obstet Gynaecol Can 2018; 40: 883-887
• 19 Aydın GA, Özsoy HGT, Akdur PÖ. et al. The predictive value of first-trimester anthropometric and ultrasonographic adipose tissue measurements in gestational diabetes mellitus. J Obstet Gynaecol Res 2021; 47: 3071-3077
• 20 Yuksel MA, Kilic F, Kayadibi Y. et al. Shear wave elastography of the placenta in patients with gestational diabetes mellitus. J Obstet Gynaecol 2016; 36: 585-588
• 21 Ohmaru T, Fujita Y, Sugitani M. et al. Placental elasticity evaluation using virtual touch tissue quantification during pregnancy. Placenta 2015; 36: 915-920
• 22 Eroğlu H, Tolunay HE, Vanlı Tonyalı N. et al. Comparison of placental elasticity in normal and intrauterine growth retardation pregnancies by ex vivo strain elastography. Arch Gynecol Obstet 2020; 302: 109-115
• 23 Hamagawa K, Matsumura Y, Kubo T. et al. Abdominal visceral fat thickness measured by ultrasonography predicts the presence and severity of coronary artery disease. Ultrasound Med Biol 2010; 36: 1769-1775
• 24 American Diabetes Association. [Guideline] 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020; 43: 14-31
• 25 Gur EB, Ince O, Turan GA. et al. Ultrasonographic visceral fat thickness in the first trimester can predict metabolic syndrome and gestational diabetes mellitus. Endocrine 2014; 47: 478-484
• 26 Tumurbaatar B, Poole AT, Olson G. et al. Adipose tissue insulin resistance in gestational diabetes. Metab Syndr Relat Disord 2017; 15: 86-92
• 27 Baliutavičienė D, Buinauskienė JB, Petrenko V. et al. Gestational diabetes, obesity, and metabolic syndrome diagnosed during pregnancy. Metab Syndr Relat Disord 2012; 10: 214-217
• 28 De Souza LR, Berger H, Retnakaran R. et al. Hepatic fat and abdominal adiposity in early pregnancy together predict impaired glucose homeostasis in mid-pregnancy. Nutr Diabetes 2016; 6: e229
• 29 Suresh A, Liu A, Poulton A. et al. Comparison of maternal abdominal subcutaneous fat thickness and body mass index as markers for pregnancy outcomes: A stratified cohort study. Aust N Z J Obstet Gynaecol 2012; 52: 420-426
• 30 Capone C, Faralli I, Vena F. et al. The role of ultrasonographic adipose tissue thickness measurement in the first trimester in predicting gestational diabetes: A prospective study. Minerva Obstet Gynecol 2023; 75: 1-6
• 31 Carrasco-Wong I, Moller A, Giachini FR. et al. Placental structure in gestational diabetes mellitus. Biochim Biophys Acta Mol Basis Dis 2020; 1866: 165535
• 32 Verma R, Mishra S, Kaul JM. et al. Cellular changes in the placenta in pregnancies complicated with diabetes. Int J Morphol 2010; 28: 259-264
• 33 Abdelghany AH, Eissa TA. Study of the ultrastructure of the placenta in gestational diabetes mellitus. Int J Anat Var 2018; 11: 4-10
• 34 Hasegawa T, Kuji N, Notake F. et al. Ultrasound elastography can detect placental tissue abnormalities. Radiol Oncol 2018; 52: 129-135