Contraception and nonalcoholic fatty liver disease in women with prior gestational diabetes mellitus

Abstract

Objectives: Nonalcoholic fatty liver disease (NAFLD) is an increasing concern among women with a history of gestational diabetes mellitus (GDM). Hormonal contraceptives may affect liver metabolism, potentially increasing NAFLD risk. This study examined the association between different contraceptive methods and NAFLD risk approximately one year postpartum in women with prior GDM.

Study design: We conducted a prospective cohort study involving 130 women with prior GDM. We categorized these women into three groups based on their contraceptive use: no contraception or non-hormonal methods (n = 86); progestin-only contraceptives (POCs), including progestin-only pills (POPs), depot medroxyprogesterone acetate (DMPA), and implants (n = 29); and combined oral contraceptives (COCs) (n = 15). At 1 year postpartum, we measured the controlled attenuation parameter to assess hepatic steatosis and diagnose NAFLD. We used multivariable logistic regression analyses to evaluate the association between contraceptive methods and NAFLD risk.

Results: The POC group had the highest median controlled attenuation parameter (307dB/m) and NAFLD prevalence (55.2%), followed by the no contraception or non-hormonal group (237dB/m; 30.2%), with the lowest values in the COC group (213dB/m; 13.3%). POCs, particularly POPs and DMPA, significantly increased the risk of NAFLD compared to no contraception or non-hormonal methods (adjusted odds ratio 4.28, 95% confidence interval 1.55-11.85). In contrast, COCs did not show a significant association with NAFLD risk.

Conclusions: POCs, particularly POPs and DMPA, significantly increased NAFLD risk, whereas COCs showed no such association. These findings have important implications for contraceptive counseling in women with prior GDM.

Implications: Healthcare providers should be cautious about the increased nonalcoholic fatty liver disease risk associated with progestin-only contraceptives, especially progestin-only pills and depot medroxyprogesterone acetate. These findings could guide contraceptive options for women with a history of gestational diabetes mellitus.

Keywords: Contraception; Fatty liver disease; Gestational diabetes mellitus; Hepatic steatosis; Nonalcoholic fatty liver disease.