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. 2025 Jun 20.
doi: 10.1007/s00592-025-02547-7. Online ahead of print.

Maternal liver fibrosis indices as predictors of adverse perinatal outcomes in patients with gestational diabetes mellitus

Murad Gezer  1 , Ümit Taşdemir  2 , Ömer Gökhan Eyisoy  2 , Sevdenur Yiğit  3 , Mucize Eriç Özdemir  2 , Oya Demirci  2
Affiliations

Maternal liver fibrosis indices as predictors of adverse perinatal outcomes in patients with gestational diabetes mellitus

Murad Gezer et al. Acta Diabetol. .

Abstract

Objective: This study aimed to evaluate the FIB-4 and APRI scores in patients with gestational diabetes mellitus (GDM) and investigate their associations with neonatal outcomes. Additionally, the predictive value of these non-invasive fibrosis indices for GDM and adverse perinatal outcomes was assessed.

Materials and methods: In this retrospective case-control study, 200 pregnant women diagnosed with GDM and 200 healthy controls were analyzed. Data on maternal demographics, laboratory parameters (ALT, AST, platelet count), FIB-4 and APRI scores, perinatal and neonatal outcomes including fetal growth restriction (FGR), oligohydramnios, polyhydramnios, birth weight, gestational age at birth, neonatal cord blood pH, neonatal hypoglycemia, Apgar 1 min. and 5 min. scores, and neonatal intensive care unit (NICU) admission were collected. Logistic regression analyses were performed to identify independent predictors of adverse perinatal outcomes among GDM patients. ROC analysis was used to determine the diagnostic performance of both indices.

Results: FIB-4 and APRI scores were significantly higher in GDM patients compared to controls (p < 0.05). Among GDM patients, those with FGR, NICU admission, or neonatal death had significantly elevated FIB-4 scores. Stratification by FIB-4 risk categories revealed that patients with high FIB-4 scores had increased rates of FGR, fetal hypoglycemia, adverse perinatal outcomes, and NICU admission (p < 0.01). ROC analysis for predicting GDM yielded AUC values of 0.577 for FIB-4 and 0.571 for APRI. For predicting adverse perinatal outcomes, the FIB-4 AUC was 0.590, while APRI showed limited predictive ability (AUC = 0.511).

Conclusion: FIB-4 can serve as a valuable non-invasive marker for liver dysfunction in GDM and is significantly associated with adverse perinatal outcomes. Despite limited predictive power, these scores may serve as early indicators of hepatic involvement in GDM.

Keywords: APRI; FIB-4 index; Gestational diabetes mellitus; Liver fibrosis; Neonatal outcomes.

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Conflict of interest statement

Declarations. Conflict of Interest: The authors have no relevant financial or non-financial interests to disclose.

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