Abstract
BACKGROUND: Gestational diabetes mellitus (GDM) is characterized by glucose intolerance first identified during pregnancy. Adipokines are adipose-derived hormones regulating insulin sensitivity, while body composition describes the body's fat and non-fat components, which change dynamically in gestation. AIM: To explore the associations between body composition, adipokines, and GDM risk, identifying early predictive markers to enhance prenatal risk assessment. METHODS: A retrospective analysis included 1656 singleton pregnant women (276 with GDM, 1380 with normal glucose tolerance) from 2020-2024. Early pregnancy (6-16 weeks) body composition was assessed via bioelectrical impedance analysis. Adipokines (leptin, adiponectin, fatty acid-binding protein 4) and metabolic indices were measured during 24-28 weeks oral glucose tolerance test. Group comparisons, logistic regression, correlation analysis, and receiver operating characteristic curves were used to evaluate relationships and diagnostic performance. RESULTS: GDM women had higher pre-pregnancy body mass index (BMI), glucose/insulin, homeostasis model assessment of insulin resistance, lower insulin sensitivity index (all P < 0.05). GDM showed higher fat mass percentage (FMP) (36.23% ± 7.54% vs 33.12% ± 9.87%), fat mass index (FMI) (9.87 ± 3.32 kg/m(2) vs 8.34 ± 4.11 kg/m(2)), extracellular-to-intracellular water ratio (ECW/ICW) (0.63 ± 0.03 vs 0.61 ± 0.02), lower lean mass indices (all P < 0.001 except ECW/ICW P = 0.012). GDM had higher leptin (P = 0.014), lower adiponectin (P = 0.021). FMP elevation was independent risk factor (odds ratio = 1.412, P = 0.030). Pre-pregnancy BMI (area under the curve = 0.662), FMP (0.651), FMI (0.650) had better diagnostic value than ECW/ICW (0.606). CONCLUSION: Body composition parameters (FMP, FMI) and adipokines (leptin, adiponectin) are closely linked to GDM risk. Integrating these assessments into prenatal care facilitates early risk identification and targeted interventions to improve maternal-fetal outcomes.