Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;9(1):e000831.
doi: 10.1136/bmjgast-2021-000831.

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)

Iresha Sandamali Koralegedara  1   2   3 , Janith Niwanthaka Warnasekara  2   3 , Korale Gedara Dayaratne  4 , Farika Nirmani De Silva  2   3 , Jagath Keerthi Premadasa  5 , Suneth Buddhika Agampodi  2   3
Affiliations

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)

Iresha Sandamali Koralegedara et al. BMJ Open Gastroenterol. 2022 Feb.

Abstract

Background and aims: Non-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.

Methods: A 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.

Results: Of 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)).

Conclusion: In 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.

Keywords: diabetes mellitus; fatty liver; liver disease in pregnancy; liver imaging.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study flow chart of the participants recruited and loss to follow-up. GDM, gestational diabetes mellitus; OGTT, oral glucose tolerance test; USS, ultrasound scan.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Younossi Z, Anstee QM, Marietti M, et al. . Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol 2018;15:11–20. 10.1038/nrgastro.2017.109 - DOI - PubMed
    1. Basaranoglu M, Neuschwander-Tetri BA. Nonalcoholic fatty liver disease: clinical features and pathogenesis. Gastroenterol Hepatol 2006;2:282–91. - PMC - PubMed
    1. Prins GH, Luangmonkong T, Oosterhuis D, et al. . A pathophysiological model of non-alcoholic fatty liver disease using precision-cut liver slices. Nutrients 2019;11:507. 10.3390/nu11030507 - DOI - PMC - PubMed
    1. Fan J-G, Kim S-U, Wong VW-S. New trends on obesity and NAFLD in Asia. J Hepatol 2017;67:862–73. 10.1016/j.jhep.2017.06.003 - DOI - PubMed
    1. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011;34:274–85. 10.1111/j.1365-2036.2011.04724.x - DOI - PubMed

Publication types

MeSH terms