Case Study: EFT in Diabetic and Non-Diabetic Pregnancies

Dr. Ravi Gunatilake published a recent article in Obesity: A Research Journal. The article provided extensive insight into the impact that gestational diabetes has on a baby’s weight. Below are the highlights of the case study.

Diabetes and Fetal Obesity

There has been evidence that the metabolic environment of a mother can affect fetal metabolism. In cases of mothers with diabetes, it has been found that babies are at risk of unhealthy weight, increased insulin resistance, inflammation, and low oxygen levels in the blood. In studies with adults, epicardial and visceral fat thickness have been used as tools for predicting these types of metabolic and cardiovascular risks.

Fetal epicardial fat thickness (EFT) is a visceral fat deposit located between the heart and pericardium (the membrane enclosing the heart). Researchers have predicted that fetal EFT would be associated with fetal abdomen circumference, glycemia, and birth weight.

In this retrospective cross-sectional study, the authors, including Dr. Gunatilake, reviewed charts of patients with fetal echocardiograms performed from 2008 to 2012. Participants were randomly selected in an effort to find 28 subjects with previous maternal history of diabetes and 28 non-diabetic pregnant patients. The echocardiograms within this study were all taken in the second trimester, between 20 and 28 weeks in the pregnancy.


Measurement of the EFT was taken by two investigators that were blind to the medical history of the patient. Along with the EFT, other measurements were collected to determine altered fetal metabolism. These markers included: maternal BMI, estimated fetal weight, birth weight, fetal abdominal circumference, and subcutaneous fat thickness.


As a result of this study, researchers found that EFT was higher in fetuses of diabetic mothers versus fetuses from non-diabetic mothers. Since this study is the first investigation into this topic, researchers believe that further analysis will reveal more information about the effects of a maternal metabolic environment on a baby.

Diabetes in pregnancy corresponds with an uncommon fat mass in newborns when compared to newborns with non-diabetic mothers. As a result, this correlation has led to excessive fat mass growth, also known as macrosomia. While other measurements are not as accurate in predicting diabetic fetopathy, this study suggests that EFT may be an improved marker for identifying this condition.

Other results of this study demonstrate that EFT of babies with diabetic mothers correlate with estimated fetal weight and abdominal circumference. However, there was no relation to birth weight. Researchers are unsure about the meaning of these relationships, but suggest that it may be explained by differences in nutrient excess in mothers with diabetes.

Although this study has shed some light on an important subject, there are still many areas of this topic to be investigated. The current results support the association between fetal epicardial fat thickness and neonatal obesity.

If you are an expectant mother and are at high-risk, talk with your Ob/Gyn about a referral to an experienced MFM specialist. Contact us to learn more.