The prevalence of gestational diabetes mellitus in women diagnosed with non-alcoholic fatty liver disease during pregnancy: A systematic review and meta-analysis

Chai, Thora Y; Rajaratnam, Romesh Mark; Deng, Difei; George, Jacob; Pasupathy, Dharmintra; Cheung, N. Wah

doi:10.1016/j.jdiacomp.2021.107991

Cited by 7 publications

(9 citation statements)

References 26 publications

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“…The observed NAFLD prevalence of 51.3% in early pregnancy seems higher than the previously reported values for Sri Lanka (18.2%),14 Canada (17.6%),10 Korea (18.4%),13 35 and the USA (14.3%–16.7%) 12. However, the prevalence in this study is not significantly different from the comparison group of non-pregnant reproductive-age women from the same geographical location 36. Therefore, irrespective of pregnancy, this high prevalence of fatty liver in this rural young women (mean age 28.8 years) needs to be taken seriously as a major predictor of future non-communicable diseases (NCDs).…”

Section: Discussion and Interpretationcontrasting

confidence: 87%

“… 12 However, the prevalence in this study is not significantly different from the comparison group of non-pregnant reproductive-age women from the same geographical location. 36 Therefore, irrespective of pregnancy, this high prevalence of fatty liver in this rural young women (mean age 28.8 years) needs to be taken seriously as a major predictor of future non-communicable diseases (NCDs).…”

Section: Discussion and Interpretationmentioning

confidence: 99%

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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)

Koralegedara

Warnasekara

Dayaratne³

et al. 2022

BMJ Open Gastroenterol

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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.

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Section: Discussion and Interpretationcontrasting

confidence: 87%

Section: Discussion and Interpretationmentioning

confidence: 99%

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)

Koralegedara

Warnasekara

Dayaratne³

et al. 2022

BMJ Open Gastroenterol

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“…The results of this national multicenter large scale population‐based study reinforce what has already been described in the literature so far 6,13,20,21,23 . We provided the first evidence of an increased odds of developing NASH in women who have been diagnosed with GDM throughout their lives.…”

Section: Discussionsupporting

confidence: 84%

“…13 A recent systematic review of three articles demonstrated that GDM is linked to the development of NAFLD, suggesting that GDM might potentiate NAFLD. 6 Taking into account that the majority of patients with a history of GDM tend to develop T2DM, 20,22,23 and that T2DM was found to be one of the most important predictors of NAFLD development and progression, 13,16,20 it is hard to interpret the association of GDM with the development of NASH or NAFL based on the current literature independently of the presence of T2DM. 13,20 Moreover, the association between GDM and NASH has not yet been established.…”

Section: Discussionmentioning

confidence: 99%

Non‐alcoholic steatohepatitis is independently associated with a history of gestational diabetes mellitus

Boustany

Onwuzo

Zeid

et al. 2023

J of Gastro and Hepatol

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Background and Aim A recent study has demonstrated that women with gestational diabetes mellitus (GDM) are more likely to develop non‐alcoholic fatty liver disease than those without GDM. In contrary to non‐alcoholic fatty liver, the association of GDM with non‐alcoholic steatohepatitis (NASH) has still not been well established in the current literature. Therefore, we aim to evaluate the association of a history of GDM and the development of NASH throughout their lives independently of type 2 diabetes mellitus (T2DM). Methods A validated research database of more than 360 hospitals was utilized to construct this study. Adult females included were divided into two groups: those with NASH (case) and individuals without NASH (control). Regression analysis was performed to account for potential cofounders. Results There were 70 632 640 individuals above the age of 18 years screened in the database. In patients with a history of GDM, NASH was most prevalent in middle age people compared with NASH alone, which was more prevalent in people aged 65 years and above. Compared with those without, patients with NASH tend to be Caucasian (odds ratio [OR]: 2.13), obese (OR: 4.83), have a history of GDM (OR: 1.23), diagnosed with hyperlipidemia (OR: 2.59), T2DM (OR: 4.52), metabolic syndrome (OR: 3.07), polycystic ovaries disease (OR: 1.72), and hypothyroidism (OR: 1.59). Conclusion We demonstrated for the first time an increased odd of developing NASH in women who have had a diagnosis of gestational diabetes mellitus throughout their lives independently of any other factors that could interfere with the results.

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“…Our study builds on the findings of prior studies assessing the consequences of MAFLD in pregnancy, especially its association with adverse maternal complications. [4][5][6][23][24][25][26][27][28] The concurrent presence of MAFLD in pregnancy may further worsen the insulin-resistant state of pregnancy, thereby increasing the risk of GDM. 24,25 We identified that women with an elevated HSI had a 1.5-fold increased odds of developing GDM, although this association was attenuated after multivariable adjustment, particularly with BMI.…”

Section: Discussionmentioning

confidence: 99%

Elevated Hepatic Steatosis Index is Associated with the Development of Adverse Maternal, but Not Adverse Neonatal, Outcomes: A Retrospective Cohort Study

Chai¹,

George²,

Pasupathy³

et al. 2023

IJWH

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Objective To determine whether an elevated hepatic steatosis index (HSI), a non-invasive test for possible metabolic dysfunction-associated fatty liver disease (MAFLD), is associated with the development of adverse pregnancy outcomes. Material and Methods A retrospective cohort study was conducted on adult women with singleton pregnancies who delivered at two tertiary hospitals from August 2014 to December 2017. Aspartate aminotransaminase (AST) and alanine aminotransaminase (ALT) levels obtained 12 months pre-gravid, or during pregnancy but prior to screening for gestational diabetes mellitus (GDM), were extracted and linked with oral glucose tolerance test results. The HSI was calculated using the following equation: 8 × (ALT/AST ratio) + BMI (+2 if female; +2 if diabetes mellitus present) and considered elevated if >36. Multiple logistic regression analysis was used to quantify the association between elevated HSI and each composite adverse pregnancy outcome after adjusting for independent maternal risk factors. Results Over 40-months, 11929 women were eligible and of these, 1885 had liver enzymes collected. Women with an elevated HSI (>36) were more likely multiparous and overweight/obese compared to those women with a non–elevated HSI (≤36). Elevated HSI was significantly associated with a composite of adverse maternal outcomes (adjusted odds ratio (aOR) 1.55 95% CI 1.11–2.17, p =0.01), although a non-significant increased risk of a composite of adverse neonatal outcomes occurred after multivariable adjustment (aOR 1.17, 95% CI 0.94–1.45, p =0.17). Conclusion Over and above known maternal risk factors, women with elevated HSI were more likely to develop adverse maternal, but not adverse neonatal outcomes.

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The prevalence of gestational diabetes mellitus in women diagnosed with non-alcoholic fatty liver disease during pregnancy: A systematic review and meta-analysis

Cited by 7 publications

References 26 publications

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)

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)

Non‐alcoholic steatohepatitis is independently associated with a history of gestational diabetes mellitus

Elevated Hepatic Steatosis Index is Associated with the Development of Adverse Maternal, but Not Adverse Neonatal, Outcomes: A Retrospective Cohort Study

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