Ultrasound assessment of foetal pancreatic circumference and gestational diabetes: a state-of-the-art of current evidence

ABSTRACT

Objective. This state-of-the-art review aims to evaluate the current evidence on the association between foetal pancreatic circumference (PC) and Gestational Diabetes Mellitus (GDM), analysing the feasibility, diagnostic performance, and methodological consistency of this novel sonographic parameter.

Materials and Methods. A comprehensive literature search was conducted to March 2025. Studies were included if they evaluated foetal PC via ultrasound in the second trimester and assessed its association with GDM. Quality was assessed using the MINORS tool. Due to the limited number and heterogeneity of studies, data were synthesized narratively.

Results. Twenty studies were screened. Three observational studies met the inclusion criteria. Two studies reported a significant association between increased foetal PC and GDM, suggesting PC ≥ 80^th percentile as a potential predictive threshold. Conversely, one study found no significant correlation. All studies confirmed the technical feasibility and reproducibility of PC measurement during mid-gestation. Quality assessment revealed moderate-to-high methodological rigour.

Conclusions. Despite preliminary results suggesting foetal PC as a promising and accessible marker for early GDM risk stratification, current evidence remains inconclusive. The novelty of this approach highlights the urgent need for standardised protocols and large-scale multicentre studies. If validated, foetal PC could offer a reliable alternative to the oral glucose tolerance test (OGTT), especially in settings where OGTT adherence is low or infeasible.

Key words

Foetal Pancreas; ultrasonography; glucose tolerance test; prenatal screening; gestational diabetes