Non-alcoholic fatty liver disease in the first trimester and subsequent development of gestational diabetes mellitus
Although there is substantial evidence that non-alcoholic fatty liver disease (NAFLD) is associated with impaired glucose homeostasis, the clinical significance of NAFLD in pregnant women has not been well determined. This study investigates the relationship between NAFLD in the first trimester and the subsequent development of gestational diabetes mellitus (GDM).
A multicentre, prospective cohort study was conducted in which singleton pregnant Korean women were assessed for NAFLD at 10–14 weeks using liver ultrasound, fatty liver index (FLI) and hepatic steatosis index (HSI). Maternal plasma adiponectin and selenoprotein P concentrations were measured. Participants were screened for GDM using the two-step approach at 24–28 weeks.
Six hundred and eight women were included in the final analysis. The prevalence of NAFLD was 18.4% (112/608) and 5.9% (36/608) developed GDM. Participants who developed GDM had a higher prevalence of radiological steatosis (55.6% vs 16.1%; p < 0.001) and higher FLI (40.0 vs 10.7; p < 0.001) and HSI (35.5 vs 29.0; p < 0.001). The risk of developing GDM was significantly increased in participants with NAFLD and was positively correlated with the severity of steatosis. This relationship between NAFLD and GDM remained significant after adjustment for metabolic risk factors, including measures of insulin resistance. Maternal plasma adiponectin and selenoprotein P levels were also correlated with both NAFLD severity and the risk of developing GDM.
NAFLD in early pregnancy is an independent risk factor for GDM. Adiponectin may be a useful biomarker for predicting GDM in pregnant women.
KeywordsGestational diabetes mellitus Insulin resistance Non-alcoholic fatty liver disease Prediction
Fatty liver index
Glucose challenge screening test
Gestational diabetes mellitus
Hepatic steatosis index
International Classification of Diseases
Non-alcoholic fatty liver disease
Some of the data were presented as an abstract at The International Liver Congress in 2018. The authors would like to thank S. Oh (the Department of Biostatistics, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea) for statistical advice.
The study was conceived and designed by SML, WK and JSP. WK and JSP supervised the study. All authors acquired, analysed or interpreted data. SML carried out statistical analysis. SML, WK and JSP drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the version to be published. SML, WK and JSP are guarantors who had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
This work was supported by a clinical research grant-in-aid from the Bio & Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science and ICT of Korea (2016M3A9B6902061) and was also supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health & Welfare, Republic of Korea (H I17C0912).
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
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