Horm Metab Res 2016; 48(09): 595-600
DOI: 10.1055/s-0042-111435
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Second Trimester Fetal and Maternal Epicardial Fat Thickness in Gestational Diabetic Pregnancies

A. Yavuz
1   Division of Perinatology, Department of Obstetrics and Gynecology, Suleyman Demirel University, Faculty of Medicine Isparta, Turkey
M. O. Akkurt
1   Division of Perinatology, Department of Obstetrics and Gynecology, Suleyman Demirel University, Faculty of Medicine Isparta, Turkey
S. Yalcin
1   Division of Perinatology, Department of Obstetrics and Gynecology, Suleyman Demirel University, Faculty of Medicine Isparta, Turkey
G. Karakoc
2   Division of Perinatology, Department of Obstetrics and Gynecology, Sifa University School of Medicine, Izmir, Turkey
E. Varol
3   Department of Cardiology, Suleyman Demirel University, Faculty of Medicine, Isparta, Turkey
M. Sezik
1   Division of Perinatology, Department of Obstetrics and Gynecology, Suleyman Demirel University, Faculty of Medicine Isparta, Turkey
› Author Affiliations
Further Information

Publication History

received 15 February 2016

accepted 28 June 2016

Publication Date:
29 July 2016 (online)


Our aim was to evaluate the association between gestational diabetes mellitus and sonographically measured fetal epicardial fat thickness between 24–28 weeks’ gestation. This was a cross-sectional study that included 40 pregnancies with gestational diabetes mellitus, matched with 40 normal pregnancies with similar maternal age, body-mass index, gestational age, fetal gender, and fetal abdominal circumference on ultrasound. Fetal epicardial fat thickness was measured and recorded during ultrasonography at 24–28 weeks of gestation. Maternal evaluation included measurement of maternal epicardial fat thickness, using echocardiography. Fetal and maternal epicardial fat thickness values were compared across the groups. Ultrasound views of fetal epicardial fat thickness were evaluated independently by 3 perinatology fellows to determine inter- and intra-observer variability. Partial and intraclass correlation analyses were used. Fetal and maternal epicardial fat thickness measurements were moderately correlated (r=0.63). Mean fetal and maternal epicardial fat thickness values were higher in gestational diabetes mellitus pregnancies (p=0.004 and p<0.0001, respectively) compared to controls. Fetal epicardial fat thickness was positively correlated (r=0.43) with postchallenge 2-h glucose values. Inter- and intra-observer agreement was high, demonstrated by strong correlations (r=0.99 and r=0.99, respectively) across fetal epicardial fat thickness measurements of the examiners. Fetuses from gestational diabetes mellitus pregnancies have significantly higher fetal and maternal epicardial fat thickness values compared to nongestational diabetes mellitus pregnancies. Fetal epicardial fat thickness obtained during second trimester fetal anatomy ultrasound may potentially be a reliable indicator for gestational diabetes mellitus. However, clinical validation studies are needed.

  • References

  • 1 Kremen J, Dolinkova M, Krajickova J, Blaha J, Anderlova K, Lacinova Z, Haluzikova D, Bosanska L, Vokurka M, Svacina S, Haluzik M. Increased subcutaneous and epicardial adipose tissue production of proinflammatory cytokines in cardiac surgery patients: possible role in postoperative insulin resistance. J Clin Endocrinol Metab 2006; 91: 4620-4627
  • 2 Sacks HS, Fain JN, Holman B, Cheema P, Chary A, Parks F, Karas J, Optican R, Bahouth SW, Garrett E, Wolf RY, Carter RA, Robbins T, Wolford D, Samaha J. Uncoupling protein-1 and related messenger ribonucleic acids in human epicardial and other adipose tissues: epicardial fat functioning as brown fat. J Clin Endocrinol Metab 2009; 94: 3611-3615
  • 3 Marchington JM, Pond CM. Site specific properties of pericardial and epicardial adipose tissue: the effects of insulin and high-fat feeding on lipogenesis and the incorporation of fatty acids in vivo. Int J Obesity 1990; 14: 1013-1022
  • 4 Cheng KH, Chu CS, Lee KT, Lin TH, Hsieh CC, Chiu CC, Voon WC, Lai WT. Adipocytokines and proinflammatory mediators from abdominal and epicardial adipose tissue in patients with coronary artery disease. Int J Obesity 2008; 32: 268-274
  • 5 Iacobellis G, Willens HJ. Echocardiographic epicardial fat: A review of research and clinical applications. J Am Soc Echocardiogr 2009; 22: 1311-1319
  • 6 Cetin M, Cakici M, Polat M, Suner A, Zencir C, Ardic I. Relation of epicardial fat thickness with carotid intima-media thickness in patients with type 2 diabetes mellitus. Int J Endocrinol 2013; 2013: 769175
  • 7 Altun B, Tasolar H, Eren N. Epicardial adipose tissue thickness in hemodialysis patients. Echocardiography 2014; 31: 941-946
  • 8 Teijeira-Fernandez E, Eiras S, Grigorian-Shamagian L, Fernandez A, Adrio B, Gonzalez-Juanatey JR. Epicardial adipose tissue expression of adiponectin is lower in patients with hypertension. J Hum Hypertens 2008; 22: 856-863
  • 9 Iacobellis G, Ribaudo MC, Assael F, Vecci E, Tiberti C, Zappaterreno A, Di Mario U, Leonetti F. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: a new indicator of cardiovascular risk. J Clin Endocrinol Metab 2003; 88: 5163-5168
  • 10 Iacobellis G, Assael F, Ribaudo MC, Zappaterreno A, Alessi G, Di Mario U, Leonetti F. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 2003; 11: 304-310
  • 11 Jeong JW, Jeong MH, Yun KH, Oh SK, Park EM, Kim YK. Echocardiographic epicardial fat thickness and coronary artery disease. Circ J 2007; 71: 536-539
  • 12 Ahn SG, Lim HS, Joe DY, Kang SJ, Choi BJ, Choi SY, Yoon MH, Hwang GS, Tahk SJ, Shin JH. Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart 2008; 94: e7
  • 13 American Diabetes Association . Diagnosis and classification of diabetes mellitus. Diabetes Care 2009; 32: 62-67
  • 14 Noussitou P, Monbaron D, Vial Y, Gaillard RC, Ruiz J. Gestational diabetes mellitus and the risk of metabolic syndrome: a population based study in Lausanne, Switzerland. Diabetes Metab 2005; 31: 361-369
  • 15 König AB, Junginger S, Reusch J, Louwen F, Badenhoop K. Gestational Diabetes Outcome in a Single Center Study: Higher BMI in Children After Six Months. Horm and Metab Res 2014; 46: 804-809
  • 16 Asemi Z, Karamali M, Esmaillzadeh A. Favorable Effects of Vitamin D Supplementation on Pregnancy Outcomes in Gestational Diabetes: A Double Blind Randomized Controlled Clinical Trial. Horm and Metab Res 2015; 47: 565-570
  • 17 Drynda R, Peters CJ, Jones PM, Bowe JE. The Role of Non-Placental Signals in the Adaptation of Islets to Pregnancy. Horm and Metab Res 2015; 47: 64-71
  • 18 American Diabetes Association . Standards of medical care in diabetes–2013. Diabetes Care 2013; 36: S11-S66
  • 19 Nakazato R, Dey D, Cheng VY, Gransar H, Slomka PJ, Hayes SW, Thomson LE, Friedman JD, Min JK, Berman DS. Epicardial fat volume and concurrent presence of both myocardial ischemia and obstructive coronary artery disease. Atherosclerosis 2012; 221: 422-426
  • 20 Iacobellis G, Zaki MC, Garcia D, Willens HJ. Epicardial Fat in Atrial Fibrillation and Heart Failure. Horm and Metab Res 2014; 46: 587-590
  • 21 Sengul C, Cevik C, Ozveren O, Oduncu V, Sunbul A, Akgun T, Can MM, Semiz E, Dindar I. Echocardiographic epicardial fat thickness is associated with carotid intima-media thickness in patients with metabolic syndrome. Echocardiography 2011; 28: 853-853
  • 22 Iacobellis G, Barbaro G, Gerstein HC. Relationship of epicardial fat thickness and fasting glucose. Int J Cardiol 2008; 128: 424-426
  • 23 Caliskan M, Caklili OT, Caliskan Z, Duran C, Ciftci FC, Avci E, Gullu H, Kulaksizoglu M, Koca H, Muderrisoglu H. Does gestational diabetes history increase epicardial fat and carotid intima media thickness?. Echocardiography 2014; 31: 1182-1187
  • 24 Nar G, Inci S, Aksan G, Unal OK, Nar R, Soylu K. The relationship between epicardial fat thickness and gestational diabetes mellitus. Diabetol Metab Syndr 2014; 6: 120
  • 25 Jackson D, Deschamps D, Myers D, Fields D, Knudtson E, Gunatilake R. Fetal epicardial fat thickness in diabetic and non-diabetic pregnancies: A retrospective cross-sectional study. Obesity 2016; 24: 167-171