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      Inter and intra-reliability of ultrasonography for the measurement of abdominal subcutaneous & visceral adipose tissue thickness at 12 weeks gestation

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          Abstract

          Background

          Excess abdominal adiposity cause metabolic disturbances, particularly in pregnancy. Methods of accurate measurement are limited in pregnancy due to risks associated with these procedures. This study outlines a non-invasive methodology for the measurement of adipose tissue in pregnancy and determines the intra- and inter-observer reliability of ultrasound (US) measurements of the two components of adipose tissue (subcutaneous (SAT) and visceral adipose tissue (VAT)) within a pregnant population.

          Methods

          Thirty pregnant women were recruited at the end of their first trimester, from routine antenatal clinic at the University Maternity Hospital Limerick, Ireland. Measurements of adipose tissue thickness were obtained using a GE Voluson E8 employing a 1–5 MHz curvilinear array transducer. Two observers, employing methodological rigour in US technique, measured thickness of adipose tissue three times, and segmented the US image systematically in order to define measurements of SAT and VAT using specifically pre-defined anatomical landmarks.

          Results

          Intra-observer and inter-observer precision was assessed using Coefficient of Variation (CV). Measurements of SAT and total adipose for both observers were < 5% CV and < 10% CV for VAT in measures by both observers. Inter-observer reliability was assessed by Limits of Agreement (LoA). LoA were determined to be − 0.45 to 0.46 cm for SAT and − 0.34 to 0.53 cm for VAT values. Systematic bias of SAT measurement was 0.01 cm and 0.10 cm for VAT. Inter-observer precision was also assessed by coefficient of variation (CV: SAT, 3.1%; VAT, 7.2%; Total adipose, 3.0%).

          Conclusion

          Intra-observer precision was found to be acceptable for measures of SAT, VAT and total adipose according to anthropometric criterion, with higher precision reported in SAT values than in VAT. Inter-observer reliability assessed by Limits-Of-Agreement (LoA) confirm anthropometrically reliable to 0.5 cm. Systematic bias was minimal for both measures, falling within 95% confidence intervals. These results suggest that US can produce reliable, repeatable and accurate measures of SAT and VAT during pregnancy.

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          Most cited references38

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          The Hyperglycemia and Adverse Pregnancy Outcome Study

          OBJECTIVE To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. RESEARCH DESIGN AND METHODS Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes. RESULTS Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m2), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93–2.47), for obesity alone 1.73 (1.50–2.00), and for both GDM and obesity 3.62 (3.04–4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women). CONCLUSIONS Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.
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            Abdominal Subcutaneous Adipose Tissue: A Protective Fat Depot?

            OBJECTIVE Obesity is associated with increased metabolic and cardiovascular risk. The ectopic fat hypothesis suggests that subcutaneous fat may be protective, but this theory has yet to be fully explored. RESEARCH DESIGN AND METHODS Participants from the Framingham Heart Study (n = 3,001, 48.5% women) were stratified by visceral adipose tissue (VAT) into sex-specific tertiles. Within these tertiles, age-adjusted abdominal subcutaneous adipose tissue (SAT) tertiles were examined in relation to cardiometabolic risk factors. RESULTS In the lowest VAT tertile, risk factor prevalence was low, although systolic blood pressure in women and rates of high triglycerides, impaired fasting glucose, hypertension, and the metabolic syndrome in men increased with increasing SAT tertile (all P < 0.04). In contrast, in the top VAT tertile, lower triglycerides were observed in men with increasing SAT (64.4% high triglycerides in SAT tertile 1 vs. 52.7% in SAT tertile 3, P = 0.03). Similar observations were made for women, although results were not statistically significant (50.6% high triglycerides in SAT tertile 1 vs. 41.0% in tertile 3, P = 0.10). Results in the highest VAT tertile were notable for a lack of increase in the prevalence of low HDL in men and women and in rates of impaired fasting glucose in men with increasing subcutaneous fat, despite sizable differences in BMI across SAT tertiles (27.1 to 36.3 kg/m2[women]; 28.1 to 35.7 kg/m2[men]). CONCLUSIONS Although adiposity increases the absolute risk of metabolic and cardiovascular disease, abdominal subcutaneous fat is not associated with a linear increase in the prevalence of all risk factors among the obese, most notably, high triglycerides.
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              Metformin versus Placebo in Obese Pregnant Women without Diabetes Mellitus.

              Obesity is associated with an increased risk of adverse pregnancy outcomes. Lifestyle-intervention studies have not shown improved outcomes. Metformin improves insulin sensitivity and in pregnant patients with gestational diabetes it leads to less weight gain than occurs in those who do not take metformin.
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                Author and article information

                Contributors
                alexandra.cremona@ul.ie
                kevin.hayes@ucc.ie
                Clodagh.ogorman@ul.ie
                ciara.nilaughin@ul.ie
                khadijah.ismail@ul.ie
                alan.donnelly@ul.ie
                jill.hamilton@sickkids.ca
                Amanda.cotter@ul.ie
                Journal
                BMC Med Imaging
                BMC Med Imaging
                BMC Medical Imaging
                BioMed Central (London )
                1471-2342
                17 December 2019
                17 December 2019
                2019
                : 19
                : 95
                Affiliations
                [1 ]ISNI 0000 0004 1936 9692, GRID grid.10049.3c, Graduate Entry Medical School (GEMS), , University of Limerick, ; Limerick, Ireland
                [2 ]ISNI 0000 0004 1936 9692, GRID grid.10049.3c, School of Allied Health (SAH), , University of Limerick, ; Limerick, Ireland
                [3 ]Institute of Nutrition & Dietetics (INDI), Dublin, Ireland
                [4 ]ISNI 0000 0004 1936 9692, GRID grid.10049.3c, Health Research Institute (HRI), , University of Limerick, ; Limerick, Ireland
                [5 ]ISNI 0000 0004 1936 9692, GRID grid.10049.3c, Physical Education and Sport Sciences (PESS), , University of Limerick, ; Limerick, Ireland
                [6 ]ISNI 0000000123318773, GRID grid.7872.a, Department of Statistics, , University College Cork (UCC), ; Cork, Ireland
                [7 ]GRID grid.488552.6, University Maternity Hospital Limerick (UMHL), ; Limerick, Ireland
                [8 ]ISNI 0000 0004 0473 9646, GRID grid.42327.30, The Hospital for Sick Children, ; Toronto, Canada
                Author information
                http://orcid.org/0000-0002-4996-1430
                Article
                393
                10.1186/s12880-019-0393-6
                6916062
                31847832
                15e495ba-5f12-4081-b535-088712d243a6
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 17 June 2019
                : 8 November 2019
                Funding
                Funded by: Dean Scholarship EHS faculty, University of Limerick, Ireland
                Award ID: None
                Award Recipient :
                Funded by: Health Research Institute
                Award ID: 53305
                Award Recipient :
                Categories
                Technical Advance
                Custom metadata
                © The Author(s) 2019

                Radiology & Imaging
                adipose,visceral,reliability,ultrasound,technique,pregnancy,subcutaneous,body composition
                Radiology & Imaging
                adipose, visceral, reliability, ultrasound, technique, pregnancy, subcutaneous, body composition

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