Non-alcoholic fatty liver disease (NAFLD): a significant predictor of gestational diabetes mellitus (GDM) and early pregnancy miscarriages—prospective study in Rajarata Pregnancy Cohort (RaPCo)

Abstract

Background and aimsNon-alcoholic fatty liver disease (NAFLD) is increasing globally with a mounting body of evidence on various adverse effects on pregnancy. Yet, prospective studies, especially from low-income and middle-income countries, are lacking in examining the impact of NAFLD in pregnancy. In this study, we explored the effect of NAFLD on the development of gestational diabetes mellitus (GDM) and early pregnancy miscarriages.MethodsA population-based prospective cohort study was conducted among first-trimester pregnant women who registered in the national pregnancy care programme during July–September 2019 in Anuradhapura district, Sri Lanka. Baseline clinical–biochemical parameters and ultrasound scan (USS) of the liver were done to assess fatty liver. Those who were normoglycaemic based on WHO criteria were followed up, and a repeat oral glucose tolerance test was performed between 24 and 28 weeks of gestation.ResultsOf the 632 pregnant women studied, 90 (14%) and 234 (37%) were diagnosed as having fatty liver grade (FLG) II and I, respectively. The cumulative incidence of GDM in FLG 0, I, and II were 11, 44, and 162 per 1000 pregnancies, respectively. After adjusting for age and other known risk factors, women with FLG II had a relative risk (RR) of 12.5 (95% CI 2.2 to 66.4) for developing GDM compared with FLG 0. In addition, women with FLG I (RR 2.1, 95% CI 1.01 to 4.64) and FLG II (RR 4.5, 95% CI 2.1 to 9.9) were significant risk factors for early pregnancy miscarriages, and FLG II remained as the only independent predictor of miscarriages after adjusting for age, parity, body mass index, blood sugar, blood pressure, and haemoglobin level (adjusted OR 4.2 (95% CI 1.9 to 9.1)).ConclusionIn this rural south Asian community, NAFLD is shown to be a major risk factor for GDM and early pregnancy miscarriages. Therefore, routine identification of NAFLD through a simple USS may help in the early identification of high-risk mothers.

Management of obesity across women's life course: FIGO Best Practice Advice

“…The prevalence of NAFLD increases with increasing BMI 46,47 . A higher incidence of gestational diabetes and early pregnancy miscarriages exists among women with NAFLD 48,49 . NAFLD can develop into nonalcoholic steatohepatitis over 5–7 years, leading to fibrosis and hepatocellular carcinoma.…”

“… 46 , 47 A higher incidence of gestational diabetes and early pregnancy miscarriages exists among women with NAFLD. 48 , 49 NAFLD can develop into nonalcoholic steatohepatitis over 5–7 years, leading to fibrosis and hepatocellular carcinoma. Nonalcoholic steatohepatitis is the second most common cause of liver transplantation and hepatocellular carcinoma.…”

Fatty Liver Index is a valid predictor of non-alcoholic fatty liver disease (NAFLD) in pregnancy

“…NAFLD has been reported as one of the underlying causes of indirect maternal deaths because it is complicated with diabetes in pregnancy, hypertension, preeclampsia and miscarriages. [11][12][13][14][15][16][17][18] Evidence suggests that the early identification of FL can minimise adverse maternal outcomes because it can predict many complications such as gestational diabetes mellitus. 8 19 NAFLD can predict metabolic syndrome, coronary artery disease, hypertension and colorectal carcinoma.…”

Clinical advances: pregnancy in gastroenterologic and hepatic conditions

“…NAFLD confers increased perinatal risks, such as hypertensive complications including Pre-E, postpartum haemorrhage and preterm birth 85. Hepatic steatosis is also associated with gestational diabetes in high-income as well as low-income and middle-income countries 87…”