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Meta-Analysis
. 2022 Jan;28(1):52-66.
doi: 10.3350/cmh.2021.0205. Epub 2021 Sep 17.

Systematic review with meta-analysis: Non-alcoholic fatty liver disease and the association with pregnancy outcomes

Hydar El Jamaly  1   2 , Guy D Eslick  3 , Martin Weltman  1   2
Affiliations
Meta-Analysis

Systematic review with meta-analysis: Non-alcoholic fatty liver disease and the association with pregnancy outcomes

Hydar El Jamaly et al. Clin Mol Hepatol. 2022 Jan.

Abstract

Background/aims: Maternal and fetal outcomes in pregnant patients with Non-alcoholic fatty liver disease (NAFLD) have been largely unexplored. To determine the level of evidence associated with maternal and fetal outcomes in pregnant women with NAFLD.

Methods: We conducted a comprehensive literature search. The studies included pregnant patients with a previous, current or subsequent diagnosis of NAFLD. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI).

Results: Twenty-two studies, with 13,641 female NAFLD patients were reviewed. The results highlight that NAFLD patients had a statistically significant increased likelihood of baseline diabetes mellitus (OR, 6.00; 95% CI, 2.21-16.31; P<0.001; n=7), baseline Hypertension (OR, 3.75; 95% CI, 2.13-6.59; P<0.001; n=4), gestational hypertension (OR, 1.83; 95% CI, 1.03-3.26; P=0.041; n=2), and pre-eclampsia (OR, 2.43; 95% CI, 1.46-4.04; P=0.001; n=3). The odds for a past and current history of gestational diabetes mellitus were OR, 3.78; 95% CI, 2.21-6.44; P<0.001; n=5 and OR, 3.23; 95% CI, 1.97- 5.31; P<0.001; n=6, respectively. As for fetal outcomes, pregnant NAFLD patients were significantly more likely to have a premature birth (OR, 2.02; 95% CI, 1.44-2.85; P<0.001; n=4), large for gestational age birth (OR, 2.01; 95% CI, 1.72-2.37; P<0.001; n=2) or a history of prior miscarriage or abortion (OR, 1.15; 95% CI, 1.02-1.30; P=0.02; n=2). Egger's regression revealed no evidence of publication bias (P>0.05).

Conclusion: This meta-analysis provides pooled evidence that NAFLD is associated with a substantial increase in maternal diabetic and hypertensive complications and multiple adverse fetal outcomes. This data is important for clinicians managing these patients before, during and after pregnancy.

Keywords: Diabetes mellitus; Hypertension; Non-alcoholic fatty liver disease; Obesity; Pregnancy complications.

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Conflict of interest statement

Conflicts of Interest

The authors have no conflicts to disclose.

Figures

Figure 1.
Figure 1.
ROBINS-I risk of bias tool for non-randomized controlled studies. Only full publication, active comparator group studies were eligible for the ROBIN-I analysis.
Figure 2.
Figure 2.
Flow chart of the search strategy used in the review.
Figure 3.
Figure 3.
Forest plot for current GDM, pre-eclampsia, premature, and LGA births. GDM, gestational diabetes mellitus; OR, odds ratio; CI, confidence interval; NAFLD, non-alcoholic fatty liver disease; LGA, large for gestational age birth.
None
See this image and copyright information in PMC

Comment in

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