Association between body composition in early pregnancy and the risk of gestational diabetes mellitus

Abstract

Background: Gestational diabetes mellitus (GDM) is a common complication during pregnancy that poses serious health risks to both mothers and their offspring. Risk factors for GDM, such as obesity, have been extensively reported. However, the association between body composition and GDM risk remains unclear. Therefore, we conducted a retrospective cohort study to investigate the relationship between body composition in early pregnancy and the risk of developing GDM.

Methods: A total of 3,159 pregnant women were enrolled between June 2020 and December 2021, with 280 (10.43%) diagnosed with GDM. Bioelectrical impedance analysis (BIA) was used to measure the percentage of body fat (PBF), fat mass (FM), fat-free mass (FFM), and lean mass (LM). Logistic regression and restricted cubic spline (RCS) analyses were performed to examine the associations between body composition and GDM risk.

Results: Compared with the bottom tertile, the top tertile levels of PBF and FM were significantly associated with an increased risk of GDM, with adjusted odds ratios (ORs) and corresponding 95% confidence intervals (95% CI) of 1.77 (1.13, 2.77) and 1.99 (1.23, 3.20), respectively. Each standard deviation (SD) increase in PBF and FM was associated with a 31% (95% CI: 1.07-1.60) and 27% (95% CI: 1.03-1.57) increased risk of GDM, respectively. RCS analysis indicated that the risk of GDM continuously increased with higher levels of PBF and FM, whereas it decreased with FFM and LM (p-overall < 0.001, p-non-linear range: 0.073-0.924). These findings provide important threshold values in predicting GDM risk, specifically 24.74% for PBF, 13.13 kg for FM, 39.81 kg for FFM, and 36.74 kg for LM.

Conclusion: The risk of GDM is positively associated with PBF and FM whereas negatively associated with FFM and LM.

Keywords: body composition; body fat percentage; fat free mass; fat mass; gestational diabetes mellitus.

Figure 1

Cubic spline regression of body composition in early pregnancy and gestational diabetes mellitus. (A) PBF, (B) FM, (C) FFM, (D) LM. The horizontal axis represents the body component value (continuity variable), and the vertical axis is the odds ratio corresponding to GDM risk. The black horizontal dashed line is the reference line for the odds ratio, while the fuchsia vertical dashed line indicates the value of the body composition when OR is 1. Solid blue lines and shadows are point estimates with corresponding 95% confidence intervals of GDM risk. PBF, percentage of body fat; FM, body fat mass; FFM, fat free mass; LM, lean mass. Adjusted for early pregnancy BMI, maternal age, ethnicity, household registration type, education level, gravidity, parity, gestational weight gain.