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    Fetal pancreas and its vascular supply as early sonographic markers associated with gestational diabetes in the second trimester
    (Wiley, 2026) Gercik Arzik, Ilayda; Golbasi, Hakan; Bayraktar, Burak; Ankara Aktas, Hale; Saglam Purut, Ceren; Emiralioglu Cakir, Zubeyde; Ceylan, Mukremin
    Objective: To evaluate fetal pancreatic size, echogenicity, and splenic artery (SA) Doppler parameters during the mid-second trimester and determine their association with gestational diabetes mellitus (GDM). Methods: This prospective case-control study included 150 singleton pregnancies between 24 and 28 weeks, comprising 60 women with GDM and 90 healthy controls. GDM diagnosis was based on the International Association of Diabetes and Pregnancy Study Groups criteria using a one-step 75-g oral glucose tolerance test. Ultrasonography was performed to measure fetal pancreatic circumference, classify echogenicity, and obtain SA Doppler indices. Results: Pancreatic circumference was significantly larger in the GDM group than in controls (7.65 +/- 0.97 cm versus 6.88 +/- 0.98 cm), remaining significant after adjusting for abdominal circumference (AC) (P < 0.001), body mass index (BMI; P = 0.001), and AC + BMI (P = 0.008). Increased echogenicity was more frequent in GDM pregnancies (85% versus 31.2%; P < 0.001). Although SA Doppler indices showed no group differences, pancreatic circumference correlated positively with SA peak systolic velocity (r = 0.232, P = 0.005) and SA time-averaged maximum velocity (r = 0.239, P = 0.003). Receiver operating characteristics analysis demonstrated modest discriminatory performance for pancreatic circumference (area under the curve [AUC] 0.708), comparable to maternal hemoglobin A1c (AUC 0.704) and higher than the homeostatic model assessment of insulin resistance (AUC 0.653). Conclusion: Fetal pancreatic circumference and echogenicity are significantly altered in GDM as early as the mid-second trimester, whereas SA Doppler parameters remain unchanged. These findings suggest that fetal pancreatic assessment may reflect concurrent metabolic changes in GDM.