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01-02-2019 | Article

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

Authors: Seung Mi Lee, Soo Heon Kwak, Ja Nam Koo, Ig Hwan Oh, Jeong Eun Kwon, Byoung Jae Kim, Sun Min Kim, Sang Youn Kim, Gyoung Min Kim, Sae Kyung Joo, Bo Kyung Koo, Sue Shin, Chanthalakeo Vixay, Errol R. Norwitz, Chan-Wook Park, Jong Kwan Jun, Won Kim, Joong Shin Park

Published in: Diabetologia | Issue 2/2019

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 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.

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Title: Non-alcoholic fatty liver disease in the first trimester and subsequent development of gestational diabetes mellitus
Authors: Seung Mi Lee
Soo Heon Kwak
Ja Nam Koo
Ig Hwan Oh
Jeong Eun Kwon
Byoung Jae Kim
Sun Min Kim
Sang Youn Kim
Gyoung Min Kim
Sae Kyung Joo
Bo Kyung Koo
Sue Shin
Chanthalakeo Vixay
Errol R. Norwitz
Chan-Wook Park
Jong Kwan Jun
Won Kim
Joong Shin Park
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Diabetologia / Issue 2/2019
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-018-4779-8

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