Fetal pancreatic, hepatic, and adipose tissue measurements in maternal diabetes mellitus: an observational cross-sectional study

Year 2026, Volume: 7 Issue: 2, 225 - 231, 27.03.2026

Fırat Ersan , Verda Alpay , Kübra Kurt Bilirer , Barış Boza , Hakan Erenel

https://izlik.org/JA57XH47EZ

Abstract

Aims: To assess the effects of maternal diabetes mellitus on fetal organ development through ultrasonographic assessment of pancreatic circumference, liver length, and subcutaneous fat thickness in gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PreGDM), and normal pregnancies. A secondary objective is to evaluate the fetal pancreas-to-liver ratio as a novel marker of the relative effects of maternal diabetes on different organs.
Methods: This prospective comparative study included 126 pregnant women divided into three groups: GDM (n=42), PreGDM (n=42), and control (n=42). Ultrasonographic measurements of fetal pancreatic circumference, liver length, and subcutaneous fat thickness were obtained between 28 and 36 weeks of gestation. Maternal demographic characteristics and birth parameters were collected from all participants. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance for detecting GDM.
Results: Significant differences were observed in all fetal organ measurements between diabetic and control groups. Fetal pancreatic circumference was increased in both GDM (90.8±19.2 mm) and PreGDM (90.4±17.0 mm) compared to controls (81.0±9.8 mm, p=0.007). Fetal liver length showed a significant increase in GDM (53.4±12.2 mm) and PreGDM (51.2±9.6 mm) versus controls (44.5±5.6 mm, p<0.001). Fetal fat thickness demonstrated the most dramatic differences: GDM (5.3±1.1 mm) and PDM (4.8±1.1 mm) versus controls (3.7±0.7 mm, p<0.001). ROC analysis revealed high diagnostic performance for fat thickness (sensitivity=85%, specificity=79%).
Conclusion: Maternal diabetes mellitus significantly affects fetal organ development, with consistent enlargement across multiple organ systems. Fetal subcutaneous fat thickness measurement shows high diagnostic potential for GDM screening, offering a valuable adjunct to traditional screening methods.

Keywords

Gestational diabetes mellitus , pregestational diabetes mellitus , fetal pancreas , fetal liver , ultrasound , prenatal diagnosis

Ethical Statement

The study was initiated with the approval of Çam and Sakura City Hospital Clinical Research Ethics Committee (approval number: 2025/95).

Supporting Institution

None none

References

• Tigli A, Baykus Y, Deniz R, et al. Metabolic biomarkers in early detection of gestational diabetes mellitus: a prospective diagnostic accuracy study. Front Med (Lausanne). 2026;13:1765602. doi:10.3389/fmed.2026.1765602
• Metzger BE, Gabbe SG, Persson B, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676-682. doi:10.2337/dc09-1848
• Wicklow B, Retnakaran R. Gestational diabetes mellitus and its implications across the life span. Diabetes Metab J. 2023;47(3):333-344. doi:10.4093/dmj.2022.0348
• Deputy NP, Kim SY, Conrey EJ, Bullard KM. Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth-United States, 2012-2016. MMWR Morb Mortal Wkly Rep. 2018;67(43):1201-1207. doi:10.15585/mmwr.mm6743a2
• Tekin S, Ocal A, Guleroglu FY, et al. Ultrasonographic evaluation of fetal liver, pancreas, thymus, and adrenal glands in diabetic versus non-diabetic pregnancies. J Clin Ultrasound. 2025;53(7):1554-1564. doi:10. 1002/jcu.24100
• Pedersen J. Weight and length at birth of infants of diabetic mothers. Acta Endocrinol (Copenh). 1954;16(4):330-342. doi:10.1530/acta.0.0160330
• Gilboa Y, Krekora M, Perlman S, et al. Sonographic measurement of the fetal pancreas in women with gestational diabetes. Arch Med Sci. 2022; 18(2):382-387. doi:10.5114/aoms/140578
• Cozma MA, Găman MA, Dobrică EC, et al. A Glimpse at the size of the fetal liver-is it connected with the evolution of gestational diabetes? Int J Mol Sci. 2021;22(15):7866. doi:10.3390/ijms22157866
• Akkaya H, Büke B, Uysal G. Fetal pancreatic hyperechogenicity may be an early ultrasonographic sign of gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2020;33(14):2387-2394. doi:10.1080/14767058.2018. 1551351
• Elessawy M, Harders C, Kleinwechter H, et al. Measurement and evaluation of fetal fat layer in the prediction of fetal macrosomia in pregnancies complicated by gestational diabetes. Arch Gynecol Obstet. 2017;296(3):445-453. doi:10.1007/s00404-017-4433-6
• Macrosomia: ACOG practice bulletin, number 216. Obstet Gynecol. 2020;135(1):e18-e35. doi:10.1097/AOG.0000000000003606
• Wang L, Qin M, Chen GQ, et al. Abnormal fasting glucose levels in the diagnosis of GDM may be associated with adverse pregnancy outcomes. Arch Gynecol Obstet. 2026;313(1):44. doi:10.1007/s00404-025-08266-2
• Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci. 2018; 19(11):3342. doi:10.3390/ijms19113342
• Stanirowski PJ, Majewska A, Lipa M, Bomba-Opoń D, Wielgoś M. Ultrasound evaluation of the fetal fat tissue, heart, liver and umbilical cord measurements in pregnancies complicated by gestational and type 1 diabetes mellitus: potential application in the fetal birth-weight estimation and prediction of the fetal macrosomia. Diabetol Metab Syndr. 2021;13(1):22. doi:10.1186/s13098-021-00634-7
• Liao R, Zhang Z, Zhang Y, et al. New measurement indicator of ultrasound assessment of the fetal pancreas based on anatomical landmarks and its application to fetuses with gestational diabetes mellitus. J Perinat Med. 2024;52(9):1002-1009. doi:10.1515/jpm-2024-0260
• Golbasi H, Bayraktar B, Golbasi C, et al. Splenic artery Doppler waveforms in gestational diabetes and association with fetal pancreas: a prospective case-control study. Fetal Diagn Ther. 2024;51(5):500-509. doi:10.1159/000539585
• Galluzzo RN, Da Correggio KS, von Wangenheim A, et al. Prenatal ultrasonographic markers of macrossomia and C-peptide in gestational diabetes mellitus: a prospective cohort study. Diagnostics (Basel). 2025; 15(16):1989. doi:10.3390/diagnostics15161989
• Iskender C, Yakut Yücel K, Dereli ML, et al. Increased fetal epicardial fat thickness: a reflecting finding for GDM and perinatal outcomes. Echocardiography. 2022;39(8):1082-1088. doi:10.1111/echo.15416
• Arica G, Yilmaz I, Kucuksuleymanoglu D, Davutoglu EA, Madazli R. Fetal pancreas measurements and the impact of gestational diabetes mellitus and fetal growth restriction. Eur J Obstet Gynecol Reprod Biol. 2025;312:114548. doi:10.1016/j.ejogrb.2025.114548
• Guleroglu FY, Ozmen AB, Bakirci IT, Dogu SY, Yılmaz I, Cetin A. Fetal pancreas size and maternal serum biomarkers glycated albumin and insulin-regulated aminopeptidase provide no potential for early prediction of gestational diabetes mellitus. Arch Gynecol Obstet. 2023; 308(5):1505-1514. doi:10.1007/s00404-022-06860-2
• Gilboa Y, Geron Y, Perlman S, et al. Predictive capacity of fetal pancreatic circumference for gestational diabetes mellitus. Ultrasound Obstet Gynecol. 2024;64(3):348-353. doi:10.1002/uog.27719
• Perović M, Garalejić E, Gojnić M, et al. Sensitivity and specificity of ultrasonography as a screening tool for gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2012;25(8):1348-1353. doi:10.3109/14767058. 2011.634458