Prediction of gestational diabetes mellitus by different obesity indices.

ABSTRACT

BACKGROUND: The incidence rates of obesity and gestational diabetes mellitus (GDM) are increasing in parallel. This study aimed to evaluate the relationship between different obesity indices, including prepregnancy body mass index (preBMI), the first-trimester abdominal circumference (AC), and first-trimester abdominal circumference/height ratio (ACHtR), and GDM, and the efficacy of these three indices in predicting GDM was assessed. METHODS: A total of 15,472 pregnant women gave birth to a singleton at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Prepregnancy weight was self-reported by study participants, body height and AC were measured by nurses at the first prenatal visit during weeks 11 to 13+6 of pregnancy. GDM was diagnosed through a 75-g oral glucose tolerance test at 24-28 gestational weeks. Using receiver operator characteristic (ROC) curve analysis, we evaluated the association between obesity indices and GDM. RESULTS: A total of 1912 women (12.4%) were diagnosed with GDM. Logistic regression analysis showed that AC, ACHtR, and preBMI (P < 0.001) were all independent risk factors for the development of GDM. In the normal BMI population, the higher the AC or ACHtR was, the more likely the pregnant woman was to develop GDM. The area under the ROC curve (AUC) was 0.63 (95% CI 0.62-0.64) for the AC, 0.64 (95% CI 0.62-0.65) for the ACHtR and 0.63 (95% CI 0.62-0.64) for the preBMI. An AC ≥ 80.3 cm (sensitivity 61.6%; specificity 57.9%), an ACHtR of ≥ 0.49 (sensitivity 67.3%; specificity 54.0%), and a preBMI ≥ 22.7 (sensitivity 48.4%; specificity 71.8%) were determined to be the best cut-off levels for identifying subjects with GDM. CONCLUSIONS: An increase in ACHtR may be an independent risk factor for GDM in the first trimester of pregnancy. Even in the normal BMI population, the higher the AC and ACHtR are, the more likely a pregnant woman is to develop GDM. AC, ACHtR in the first trimester and preBMI might be anthropometric indices for predicting GDM, but a single obesity index had limited predictive value for GDM.