Vol 94, No 4 (2023)
Research paper
Published online: 2022-05-24

open access

Page views 2649
Article views/downloads 844
Get Citation

Connect on Social Media

Connect on Social Media

Assessment of fetal thymus size and BMI in pregnant women with diabetes

Katarzyna Zych-Krekora1, Mariusz Grzesiak1, Piotr Kaczmarek2, Sharon Perlman3, Ron Bardin3, Yinon Gilboa3, Michal Krekora1
Pubmed: 35894499
Ginekol Pol 2023;94(4):309-314.


Objectives: The purpose of this study is to demonstrate whether diabetes during pregnancy affects the development of the fetal immune system. The background: evaluation of potential complications in diabetic pregnancy. The objective is evaluation of the significance of a new ultrasound method of thymus size in pregnancies complicated by diabetes.
Material and methods: The analysis was performed with the use of IBM SPSS Statistics 25.0 software. The Mann–Whitney U test was used for comparison of two groups, i.e., diabetic pregnancies and non-diabetic pregnancies, whereas Kruskal–Wallis H test was used to compare multiple groups. A linear regression model was used to determine the correlation between the type of diabetes and fetal thymus size as well as between maternal body mass index (BMI) and fetal thymus size. The significance level α was set at 0.05.
Results: A comparison between diabetic and non-diabetic pregnancies was made with the use of Kruskal–Wallis H test. The compared groups included women without gestational diabetes, with pre-gestational diabetes, gestational diabetes managed by diet and gestational diabetes treated with insulin and diet. The analysis revealed significant differences between the compared groups, H (3) = 23.06; p < 0.001; ƞ2 = 0.04. The additional post hoc Dunn’s test with Bonferroni correction of the significance level was used to explore specific differences between group means. The results of this detailed analysis indicated that foetuses of diabetic mothers treated with diet had smaller thymus than foetuses of non-diabetic mothers (p = 0.001). Linear regression analysis was used to establish whether maternal BMI (defined as the body mass divided by the square of the body height and expressed in units of kg/m²) affects fetal thymus size. The analysis found no correlation between maternal BMI divided into the following categories: 18.5–24.99 normal weight, 25–29.99 overweight, 30.00–34.99 obese class I, 35.00–39.99 obese class II and ≥ 40.00 very severely obese, and fetal thymus size, b = −1.82; SE = 2.17; t = −0.84; p = 0.405; R2 < 0.01.
Conclusions: Thymus size is statistically smaller in foetuses of diabetic mothers when compared to healthy controls. Overweighted and obese pregnancy is not a factor affecting fetal thymus size.

Article available in PDF format

View PDF Download PDF file


  1. Zych-Krekora K, Krekora M, Słodki M, et al. Nomograms of the fetal thymus for clinical practice. Arch Med Sci. 2021; 17(6): 1657–1662.
  2. Haynes BF, Heinly CS. Early human T cell development: analysis of the human thymus at the time of initial entry of hematopoietic stem cells into the fetal thymic microenvironment. J Exp Med. 1995; 181(4): 1445–1458.
  3. Poliani PL, Facchetti F, Ravanini M, et al. Early defects in human T-cell development severely affect distribution and maturation of thymic stromal cells: possible implications for the pathophysiology of Omenn syndrome. Blood. 2009; 114(1): 105–108.
  4. Bataeva R, Bellsham-Revell H, Zidere V, et al. Reliability of fetal thymus measurement in prediction of 22q11.2 deletion: a retrospective study using four-dimensional spatiotemporal image correlation volumes. Ultrasound Obstet Gynecol. 2013; 41(2): 172–176.
  5. Chaoui R, Kalache KD, Heling KS, et al. Absent or hypoplastic thymus on ultrasound: a marker for deletion 22q11.2 in fetal cardiac defects. Ultrasound Obstet Gynecol. 2002; 20(6): 546–552.
  6. Cossu F. Genetics of SCID. Ital J Pediatr. 2010; 36(76).
  7. Bravo-Valenzuela NJ, Peixoto AB, Araujo Júnior E. Prenatal diagnosis of congenital heart disease: A review of current knowledge. Indian Heart J. 2018; 70(1): 150–164.
  8. Respondek-Liberska M. Fetal thymus - review. Prenat Cardio. 2014; 4(1): 9–12.
  9. Cromi A, Ghezzi F, Raffaelli R, et al. Ultrasonographic measurement of thymus size in IUGR fetuses: a marker of the fetal immunoendocrine response to malnutrition. Ultrasound Obstet Gynecol. 2009; 33(4): 421–426.
  10. Di Naro E, Cromi A, Ghezzi F, et al. Fetal thymic involution: a sonographic marker of the fetal inflammatory response syndrome. Am J Obstet Gynecol. 2006; 194(1): 153–159.
  11. Caissutti C, Familiari A, Khalil A, et al. Small fetal thymus and adverse obstetrical outcome: a systematic review and a meta-analysis. Acta Obstet Gynecol Scand. 2018; 97(2): 111–121.
  12. Hu M, Eviston D, Hsu P, et al. BIS Investigator Group. Decreased maternal serum acetate and impaired fetal thymic and regulatory T cell development in preeclampsia. Nat Commun. 2019; 10(1): 3031.
  13. Palmer AC. Nutritionally mediated programming of the developing immune system. Adv Nutr. 2011; 2(5): 377–395.
  14. Diemert A, Hartwig I, Pagenkemper M, et al. Fetal thymus size in human pregnancies reveals inverse association with regulatory T cell frequencies in cord blood. J Reprod Immunol. 2016; 113: 76–82.
  15. Warncke K, Lickert R, Eitel S, et al. Thymus Growth and Fetal Immune Responses in Diabetic Pregnancies. Horm Metab Res. 2017; 49(11): 892–898.
  16. Dörnemann R, Koch R, Möllmann U, et al. Fetal thymus size in pregnant women with diabetic diseases. J Perinat Med. 2017; 45(5): 595–601.
  17. Ghalandarpoor-Attar SN, Borna S, Ghalandarpoor-Attar SM, et al. Measuring fetal thymus size: a new method for diabetes screening in pregnancy. J Matern Fetal Neonatal Med. 2020; 33(7): 1157–1161.
  18. Paolino M, Koglgruber R, Cronin SJF, et al. RANK links thymic regulatory T cells to fetal loss and gestational diabetes in pregnancy. Nature. 2021; 589(7842): 442–447.
  19. Yildirim M, Ipek A, Dauletkazin G, et al. Sonographic measurement of the fetal thymus: Relationship with maternal obesity. J Clin Ultrasound. 2017; 45(5): 277–281.
  20. Torloni MR, Betrán AP, Horta BL, et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev. 2009; 10(2): 194–203.
  21. Najafi F, Hasani J, Izadi N, et al. The effect of prepregnancy body mass index on the risk of gestational diabetes mellitus: A systematic review and dose-response meta-analysis. Obes Rev. 2019; 20(3): 472–486.
  22. Pudło H, Respondek M. Nutritional programming - the impact of nutrition of pregnant women on the health of their children. J Educ Health Sport. 2016; 6(7): 589–600.
  23. Kinsner M, Kazimierska A. Metabolic programming. 2/2018. 5-18. https://www.researchgate.net/publication/334230922 (6.02.2022).
  24. Koletzko B. Early nutrition and long term health. In: Koletzko B. ed. Pediatric Nutrition In Practice. Switzerland, Karger, Basel 2008: 37–41.