title: Increased fetal adiposity prior to diagnosis of gestational diabetes in South Asians: more evidence for the 'thin-fat' baby.
abstract: Gestational diabetes mellitus (GDM) is associated with an increased future risk of obesity in the offspring. Increased adiposity has been observed in the newborns of women with GDM. Our aim was to examine early fetal adiposity in women with GDM.
  
  
  
  Obstetric and sonographic data was collated for 153 women with GDM and 178 controls from a single centre in Chennai, India. Fetal head circumference (HC), abdominal circumference (AC), femur length (FL) and biparietal diameter (BPD) were recorded at 11, 20 and 32 weeks. Anterior abdominal wall thickness (AAWT) as a marker of abdominal adiposity at 20 and 32 weeks was compared between groups. Adjustments were made for maternal age, BMI, parity, gestational weight gain, fetal sex and gestational age.
  
  
  
  Fetuses of women with GDM had significantly higher AAWT at 20 weeks (β 0.26 [95% CI 0.15, 0.37] mm, p < 0.0001) despite lower measures of HC, FL, BPD and AC. AAWT remained higher in the fetuses of women with GDM at 32 weeks (β 0.48 [0.30, 0.65] mm, p < 0.0001) despite similar measures for HC, FL, BPD and AC between groups. Both groups had similar birthweights at term. There was an independent relationship between fasting plasma glucose levels and AAWT after adjustment as described above.
  
  
  
  A 'thin but fat' phenotype signifying a disproportionate increase in adiposity despite smaller or similar lean body mass was observed in the fetuses of mothers with GDM, even at 20 weeks, thus pre-dating the biochemical diagnosis of GDM. Increased AAWT may serve as an early marker of GDM.
authors.affiliation: Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK.
authors.forename: Hema
authors.initials: H
authors.lastname: Venkataraman
authors.affiliation: Seethapathy Clinic and Hospital, Chennai, India.
authors.forename: Uma
authors.initials: U
authors.lastname: Ram
authors.affiliation: Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Craik
authors.affiliation: Seethapathy Clinic and Hospital, Chennai, India.
authors.forename: Anuradhai
authors.initials: A
authors.lastname: Arungunasekaran
authors.affiliation: Mediscan Systems, Mylapore, Chennai, India.
authors.forename: Suresh
authors.initials: S
authors.lastname: Seshadri
authors.affiliation: Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK. p.saravanan@warwick.ac.uk.|Department of Diabetes, Endocrinology & Metabolism, George Eliot Hospital, Nuneaton, UK. p.saravanan@warwick.ac.uk.
authors.forename: Ponnusamy
authors.initials: P
authors.lastname: Saravanan
mesh_terms: D034861:Abdominal Wall / Q000503:physiopathology; D050154:Adiposity / Q000502:physiology*; D000328:Adult; D001699:Biometry; D001724:Birth Weight / Q000502:physiology; D001823:Body Composition / Q000502:physiology; D015992:Body Mass Index; D016640:Diabetes, Gestational / Q000503:physiopathology*; D005260:Female; D005865:Gestational Age; D005951:Glucose Tolerance Test; D006801:Humans; D007194:India; D009765:Obesity / Q000503:physiopathology; D011247:Pregnancy; D012189:Retrospective Studies
keywords: Abdominal fat; Fetal adiposity; Gestational diabetes; Intrauterine programming; Offspring metabolic risk; Prediction