Non-alcoholic fatty liver disease in the first trimester and subsequent development of gestational diabetes mellitus

Abstract

Aims/hypothesis 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). Methods 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.Results 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 Won Kim and Joong Shin Park contributed equally to this work.Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00125-018-4779-8) contains peer-reviewed but unedited supplementary material, which is available to authorised users. 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. Conclusions/interpretation NAFLD in early pregnancy is an independent risk factor for GDM. Adiponectin may be a useful biomarker for predicting GDM in pregnant women.

Liver disease in pregnancy

“…55 GDM is the most common metabolic disorder in pregnancy, and its association with NAFLD is likely to be bidirectional. 56 NAFLD in the first trimester is significantly associated with an increased risk of GDM, 57,58 whereas prior GDM is also a predictor of postpartum NAFLD. 59 To reduce the burden of NAFLD on mothers and fetuses, it is extremely important to control antepartum hyperglycemia, prevent GDM, and avoid excess weight gain during pregnancy.…”

Fatty Liver Index and Serum Copeptin as Early Predictors of Gestational Diabetes Mellitus in Non-diabetic Pregnant Women

“…Fatty liver index (FLI) calculated by using 4 variables: BMI (kg/m 2 ), waist circumference (cm), TG (mg/ml), and GGT (U/L) and ranges from 0 to 100. A FLI value < 30 rules out FL, so needs no intervention, while FLI value ≥60 indicates FL that needs therapy and in between is the grey zone that can be adjusted by lifestyle change and dieting regimen (17).…”

“…A number of indices that consist of simple measures were introduced to diagnose FLD [16]. Fatty liver index (FLI) is one of these indices developed as a convenient tool based on BMI, waist circumference (WC), triglyceride (TG), and gamma glutamyl transferase (GGT) levels [17,18]. The current study tried to evaluate the validity of determination of FLD and estimation of serum CP at the 6th gestational week (GW) as early predictors for development of gestational DM (GDM) later on during pregnancy in nondiabetic pregnant women.…”

Metabolic syndrome and pregnancy. Is there a gastroenterological trace?

“…Необходимо отметить, что в настоящее время накоплены факты, позволяющие говорить о существовании двунаправленной взаимосвязи между НАЖБП и ГСД. С одной стороны, было показано, что у женщин с НАЖБП, диагностированной в первом триместре беременности, во 2 триместре более часто выявляется дисгликемия и ГСД [49]. С другой стороны, установлено, что наличие в анамнезе женщин ГСД повышает впоследствии риск развития НАЖБП [50].…”

“…По мнению ряда авторов, эта связь может быть обусловлена адипокин-и гепатокин-опосредованным ответом. Результаты, полученные Lee SM et al, свидетельствуют, что низкая концентрация адипонектина и высокий уровень селенопротеина-р у беременных являются независимыми предикторами тяжести НАЖБП и возникновения в поздние сроки беременности ГСД [49,51].…”