Adiposity, Body Composition, and Cardiometabolic Outcomes in Women with and Without Gestational Diabetes

Aims: Gestational diabetes mellitus (GDM) is associated with increased long-term cardiometabolic risk. The value of body composition measures in predicting adverse cardiometabolic outcomes after GDM remains uncertain. Methods: In this prospective observational study, 757 women (300 controls and 457 with GDM in their index pregnancy) attended a postnatal assessment at a median of 5.8 (IQR 5.1–7.1) months after delivery. Anthropometric measures, biochemical markers, cardiovascular assessments, and body composition by bioelectrical impedance analysis were obtained. Outcomes included dysglycaemia, dyslipidaemia, hypertension, metabolic syndrome and liver steatosis. Multivariable logistic regression models evaluated associations and predictive performance. Results: Compared with controls, women with prior GDM had higher BMI, central adiposity, and fat mass (all p < 0.001). They also had a higher prevalence of dysglycaemia (42.9% vs. 16.7%), hypertension (30.2% vs. 18.7%), dyslipidaemia (6.3% vs. 3.0%), and liver steatosis (33.3% vs. 14%; all p < 0.05). BMI and waist-to-height ratio improved prediction of adverse outcomes beyond maternal characteristics alone. Body composition measures were associated with cardiometabolic outcomes but did not show superior discriminatory performance compared with conventional anthropometric measures. Conclusions: Women with prior GDM have a high burden of postpartum cardiometabolic abnormalities. While body composition provides additional biological insight, simple anthropometric measures remain the practical first-line tools for risk stratification.