BaCKgRoUND aND aIMS: Gestational diabetes seems to be associated with offspring NAFLD. We hypothesized that maternal glucose concentrations across the full range may have persistent effects on offspring liver fat accumulation.appRoaCH aND ReSUltS: In a multiethnic, populationbased, prospective cohort study among 2,168 women and their offspring, maternal early-pregnancy glucose concentrations were measured at a median of 13.1 weeks' gestation (95% CI, 9.6-17.2). Liver fat fraction was measured at 10 years by MRI. NAFLD was defined as liver fat fraction ≥5.0%. We performed analyses among all mothers with different ethnic backgrounds and those of European ancestry only. The multiethnic group had a median maternal early-pregnancy glucose concentration of 4.3 mmol/L (interquartile range, 3.9-4.9) and a 2.8% (n = 60) prevalence of NAFLD. The models adjusted for child age and sex only showed that in the multiethnic group, higher maternal early-pregnancy glucose concentrations were associated with higher liver fat accumulation and higher odds of NAFLD, but these associations attenuated into nonsignificance after adjustment for potential confounders. Among mothers of European ancestry only, maternal early-pregnancy glucose concentrations were associated with increased odds of NAFLD (OR, 1.95; 95% CI, 1.32; 2.88, after adjustment for confounders) per 1-mmol/L increase in maternal earlypregnancy glucose concentration. These associations were not explained by maternal prepregnancy and childhood body mass index, visceral fat, and metabolic markers.
CoNClUSIoNS:In this study, maternal early-pregnancy glucose concentrations were only among mothers of European ancestry associated with offspring NAFLD. The associations of higher maternal early-pregnancy glucose concentrations with offspring NAFLD may differ between ethnic groups. (Hepatology 2021;0:1-12). P re-existing diabetes and gestational diabetes are complicating up to 25% of pregnancies. (1)(2)(3) Recent studies suggest that gestational diabetes leads to impaired offspring cardiovascular and metabolic health in childhood and adulthood. (4)(5)(6)(7) The observed associations seem not to be restricted to the clinical diagnosis of gestational diabetes, but are also present across the full range of maternal glucose concentrations. (8)(9)(10) Previous studies suggest that gestational diabetes is also associated with offspring markers of liver pathology. (11)(12)(13)(14)(15)(16) Results from animal studies suggest that offspring of maternal pregnancy hyperglycemia are predisposed to develop liver steatosis. (13)(14)(15)(16) In humans, a case-control study among 25 mothers showed that intrahepatocellular lipid content, as measured by MR spectroscopy, was increased in neonates of mothers with both obesity and gestational diabetes compared to neonates of mothers with both normal Abbreviations: BMI, body mass index; IDEAL IQ, iterative decomposition of water and fat with echo asymmetry and least squares estimation; SDS, standard deviation score.