Ravi Retnakaran1,2,3, Jin Luo4, Baiju R Shah5,6,7,8. 1. Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada. 2. Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada. 3. Division of Endocrinology, University of Toronto, Toronto, ON, Canada. 4. Institute for Clinical and Evaluative Sciences, Toronto, ON, Canada. 5. Division of Endocrinology, University of Toronto, Toronto, ON, Canada. baiju.shah@ices.on.ca. 6. Institute for Clinical and Evaluative Sciences, Toronto, ON, Canada. baiju.shah@ices.on.ca. 7. Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room G106, Toronto, ON, M4N 3M5, Canada. baiju.shah@ices.on.ca. 8. Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada. baiju.shah@ices.on.ca.
Abstract
AIMS/HYPOTHESIS: In common with type 2 diabetes, gestational diabetes mellitus (GDM) is associated with a propensity for hepatic fat deposition. We hypothesised that GDM predicts future lifetime risk of serious liver-disease outcomes, such as cirrhosis, liver failure and need for transplantation. METHODS: From population-based administrative databases, we identified all women in Ontario, Canada, who had a pregnancy resulting in live birth between April 1994 and March 2002 (N = 698,078). This population was stratified into individuals with (n = 17,932) and without (n = 680,146) GDM, and both groups were further stratified according to subsequent development of type 2 diabetes in the years after delivery. The median follow-up for the development of serious liver disease (defined as hospitalisation for cirrhosis, liver failure or transplantation) was 14.0 years. RESULTS: Women with GDM had a higher risk of serious liver disease than those without GDM (n = 680,146; HR = 1.40, 95% CI 1.01, 1.94). Compared with women who did not have GDM and did not develop diabetes (n = 635,998), those with GDM who subsequently developed type 2 diabetes (n = 8567) had a higher risk of serious liver disease (adjusted HR = 1.56, 95% CI 1.02, 2.39), as did those without GDM who developed type 2 diabetes (n = 44,148; adjusted HR = 2.48, 95% CI 2.10, 2.93), but not those with GDM who did not develop type 2 diabetes (n = 9365; adjusted HR = 1.15, 95% CI 0.69, 1.91). CONCLUSION/ INTERPRETATION: GDM is associated with future risk of serious liver disease in young women, the development of which may be dependent upon progression to non-gestational diabetes.
AIMS/HYPOTHESIS: In common with type 2 diabetes, gestational diabetes mellitus (GDM) is associated with a propensity for hepatic fat deposition. We hypothesised that GDM predicts future lifetime risk of serious liver-disease outcomes, such as cirrhosis, liver failure and need for transplantation. METHODS: From population-based administrative databases, we identified all women in Ontario, Canada, who had a pregnancy resulting in live birth between April 1994 and March 2002 (N = 698,078). This population was stratified into individuals with (n = 17,932) and without (n = 680,146) GDM, and both groups were further stratified according to subsequent development of type 2 diabetes in the years after delivery. The median follow-up for the development of serious liver disease (defined as hospitalisation for cirrhosis, liver failure or transplantation) was 14.0 years. RESULTS:Women with GDM had a higher risk of serious liver disease than those without GDM (n = 680,146; HR = 1.40, 95% CI 1.01, 1.94). Compared with women who did not have GDM and did not develop diabetes (n = 635,998), those with GDM who subsequently developed type 2 diabetes (n = 8567) had a higher risk of serious liver disease (adjusted HR = 1.56, 95% CI 1.02, 2.39), as did those without GDM who developed type 2 diabetes (n = 44,148; adjusted HR = 2.48, 95% CI 2.10, 2.93), but not those with GDM who did not develop type 2 diabetes (n = 9365; adjusted HR = 1.15, 95% CI 0.69, 1.91). CONCLUSION/ INTERPRETATION: GDM is associated with future risk of serious liver disease in young women, the development of which may be dependent upon progression to non-gestational diabetes.
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