Fetal Femur Length Linked to Risk of Diabetes in Adolescence, Finds Cohort Study

Diabetes typically manifests more prominently in adulthood but can remain latent during childhood, often originating during early fetal development. Within fetal biometry, femur length (FL) measurement is critical in evaluating fetal growth and developmental progress. Urme Binte Sayeed, University of Tsukuba, Tsukuba, Ibaraki, Japan, and colleagues aimed to assess potential associations between fetal femur growth and prediabetic biomarkers in Bangladeshi children.

For this purpose, the researchers conducted a cohort study embedded in a population-based maternal food and micronutrient supplementation (MINIMat) trial in Matlab, Bangladesh. The cohort of children were monitored until they reached 15 years of age.

The original trial began by confirming pregnancy via ultrasound before reaching 13 gestational weeks (GWs). Subsequently, additional ultrasound assessments were conducted at 14, 19, and 30 GWs. Femur length (FL) was measured across its entirety to capture a comprehensive image of fetal development. Standardization of FL according to gestational week (GW) was performed, followed by calculation of z-scores. Plasma levels of fasting blood glucose (FBG) and glycated hemoglobin (HbA1c), as well as the triglyceride-glucose index—a marker of insulin resistance—were determined from whole blood.

The researchers conducted multivariable linear regression analysis using a generalized linear model to examine the impact of FL at 14, 19, and 30 GWs on prediabetic biomarkers at ages 9 and 15 years. Covariates in the analysis included maternal micronutrient and food supplementation group, parity, child sex, and BMI at ages 9 and 15 years.

The following were the key findings of the study:

· 1.2% of the participants had impaired fasting glucose during preadolescence, which increased to 3.5% during adolescence.

· At nine years, 6.3% of the participants had elevated HbA1c%, which increased to 28% at 15 years.

· There was an increase in the TyG index from 9.5% (during preadolescence) to 13% (during adolescence).

· A one standard deviation decrease in FL at 14 and 19 GWs was associated with increased FBG (β = − 0.44; β = − 0.59) and HbA1c (β = − 0.01; β = − 0.01) levels at 15 years. FL was not associated with diabetic biomarkers at nine years.

In conclusion, the researchers found that a shorter fetal femur length during mid-pregnancy may be associated with increased prediabetic biomarkers among Bangladeshi adolescents. The study provided evidence indicating that reduced fetal femur length may raise prediabetes risk in adolescents.

Adolescence marks a critical period for the early emergence of chronic diseases. Consequently, it is essential to conduct additional research to elucidate the potential link between fetal growth restriction and the development of metabolic disorders in adulthood, independent of lifestyle modifications. Furthermore, educating prospective parents on pre-pregnancy nutrition and adopting practices that support healthy fetal development are crucial steps to mitigate the occurrence of fetal growth restriction and low birth weight.

Reference:

Sayeed, U.B., Akhtar, E., Roy, A.K. et al. Fetal femur length and risk of diabetes in adolescence: a prospective cohort study. Trop Med Health 52, 44 (2024). https://doi.org/10.1186/s41182-024-00611-6