{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:03:01Z","timestamp":1789448581098,"version":"build-2803163510"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Gestational diabetes mellitus (GDM) is commonly diagnosed at 24\u201328 weeks of gestation; however, metabolic susceptibility that precedes dysglycemia may emerge earlier. We examined whether the rate of early pregnancy body mass index (BMI)-derived estimated body fat percentage (eBFP) change was associated with subsequent GDM, and whether this association differed according to an early hepatic\u2013metabolic phenotype defined by the natural log-transformed fatty liver index (FLI_Ln). This secondary analysis used de-identified data from a prospective Korean pregnancy cohort and included 583 singleton pregnant women without pregestational diabetes, of whom 37 developed GDM. eBFP was estimated from BMI and maternal age, and the early-pregnancy eBFP change rate was calculated from pre-pregnancy to 10\u201314 weeks of gestation and scaled so that each one-unit increase represented a 0.1 percentage-point\/week higher change rate. Multivariate logistic regression, restricted cubic splines, threshold analysis, subgroup interaction testing, exploratory mediation analysis, and propensity score\u2013matched sensitivity analyses were also performed. After adjustment for maternal age, parity, pre-pregnancy BMI, a higher eBFP change rate was associated with increased odds of subsequent GDM (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.14\u20132.21; P\u00a0=\u00a00.006), with an approximately linear dose\u2013response pattern. The FLI_Ln showed a nonlinear association with GDM, with a data-derived threshold of 2.90. The eBFP change rate\u2013GDM association was evident among women with FLI_Ln \u22652.90 (OR, 1.82; 95% CI, 1.22\u20132.71; P\u00a0=\u00a00.004), but not among those with FLI_Ln &amp;lt;2.90 (OR, 0.51; 95% CI, 0.22\u20131.20; P\u00a0=\u00a00.123; P for interaction = 0.018). Exploratory mediation analyses suggested that FLI_Ln partially accounted for the observed association, although the magnitude of this mediation was imprecisely estimated. In this secondary cohort analysis, a faster early-pregnancy BMI-derived adiposity change was associated with a higher risk of GDM, particularly among women with an elevated composite hepatic\u2013metabolic phenotype. These findings support an early adiposity\u2013hepatic metabolic susceptibility framework for GDM risk enrichment but require external validation before clinical application.<\/jats:p>","DOI":"10.3389\/fendo.2026.1889628","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:27:22Z","timestamp":1789446442000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early-pregnancy BMI-derived adiposity change rate and gestational diabetes mellitus risk: modification by a fatty liver index\u2013defined hepatic-metabolic phenotype"],"prefix":"10.3389","volume":"17","author":[{"given":"Jing","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Affiliated Hospital of Jiangnan University, Jiangnan University","place":["Wuxi, China"]},{"name":"School of Biotechnology, Jiangnan University","place":["Wuxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingjie","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency, Shishi Municipal Hospital","place":["Shishi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengjia","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Wenzhou Medical University","place":["Rui\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binbin","family":"Shao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Affiliated Hospital of Jiangnan University, Jiangnan University","place":["Wuxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Affiliated Hospital of Jiangnan University, Jiangnan University","place":["Wuxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Affiliated Hospital of Jiangnan University, Jiangnan University","place":["Wuxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"B1","unstructured":"Brussels, Belgium\n          International Diabetes Federation\n          IDF Diabetes Atlas, 11th Edn\n          \n          2025"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1361","article-title":"Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis","volume":"369","author":"Vounzoulaki","year":"2020","journal-title":"BMJ"},{"key":"B3","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1186\/s12933-024-02416-7","article-title":"Gestational diabetes mellitus and development of intergenerational overall and subtypes of cardiovascular diseases: a systematic review and meta-analysis","volume":"23","author":"Chen","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.2337\/dc26-S015","article-title":"15. 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