Introduction
Gestational diabetes mellitus (GDM) refers to carbohydrate intolerance
of varying degrees that occurs for the first time, during pregnancy
[1]. The etiopathogenesis of the disease is still not fully
understood. Inflammatory factors leading to insulin resistance and beta
cell dysfunction triggered by placental hormones play an important role
in the etiopathogenesis of the disease, along with obesity, genetic and
environmental factors [2-5]. GDM remains a significant pregnancy
complication causing adverse perinatal outcomes such as fetal
macrosomia, birth trauma, birth polyhydramnios, respiratory distress
syndrome, preterm birth, hypoglycemia, and operative delivery.
[1,6,7]. It is well known that fetuses exposed to the effects of
hyperinsulinemia and hyperglycemia during the intrauterine period may
have poor outcomes, including the need for intensive care and low Apgar
scores in the neonatal period. There is also an increased risk of
long-term complications such as type 2 diabetes mellitus (DM),
cardiovascular disease, obesity, and metabolic syndrome in these
individuals [7-9].
Epicardial adipose tissue (EAT) is located between the visceral
pericardium and the myocardium but is more prominent in the
atrioventricular and interventricular grooves and the right ventricular
sidewall [10,11]. It is derived from splanchnic mesoderm and shares
a common embryological origin with omental and mesenteric fat
[11,12]. In addition to adipose tissue, EAT also contains neuronal
and nodular structures. It shows endocrine, immunological and
inflammatory activities with its energy storage function. [13-15].
Moreover, an increase in epicardial fat thickness (EFT) has been shown
to be associated with DM, cardiovascular disease and obesity
[16-19]. Therefore, it is considered an important cardiometabolic
marker in adults [20,21].
There are few studies that investigated the measurement of EFT in
fetuses of mothers with GDM [22-25]. The need for markers that can
help predict the occurrence of GDM and the increased risk of GDM-related
perinatal complications remains one of the main topics of current
studies. Because previous studies have shown that the increase in fetal
adipose tissue in fetuses with GDM occurs most frequently in the 3rd
trimester, we aimed to compare fetal EFT in the 3rd trimester in cases
diagnosed with GDM with fetuses from healthy mothers [6,22]. To the
best of our knowledge, this is the first paper to address the assessment
of fetal EFT in patients with GDM and its relationship to neonatal
outcomes and to determine the most appropriate cut-off value of EFT for
predicting GDM in the 3rd trimester.