Seung Mi Lee1, Soo Heon Kwak2, Ja Nam Koo3, Ig Hwan Oh3, Jeong Eun Kwon3,4, Byoung Jae Kim1,5, Sun Min Kim1,5, Sang Youn Kim6, Gyoung Min Kim7, Sae Kyung Joo2,8, Bo Kyung Koo2,8, Sue Shin9,10, Chanthalakeo Vixay11, Errol R Norwitz12, Chan-Wook Park1, Jong Kwan Jun1, Won Kim13,14, Joong Shin Park15. 1. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Seoul, Jongno-gu, 03080, South Korea. 2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. 3. Seoul Women's Hospital, Incheon, South Korea. 4. Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Gyeonggi-do, South Korea. 5. Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea. 6. Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea. 7. Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea. 8. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Seoul, Dongjak-gu, 07061, South Korea. 9. Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea. 10. Department of Laboratory Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea. 11. Department of Obstetrics and Gynecology, University of Health Sciences, Vientiane, Lao PDR. 12. Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA. 13. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. drwon1@snu.ac.kr. 14. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Seoul, Dongjak-gu, 07061, South Korea. drwon1@snu.ac.kr. 15. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Seoul, Jongno-gu, 03080, South Korea. jsparkmd@snu.ac.kr.
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.
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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