Gestational diabetes

ADC 2021: High rate of MAFLD in women with gestational diabetes

Australian women with gestational diabetes have a high rate of co-existing metabolic associated fatty liver disease (MAFLD), the national diabetes meeting has been told.

A study of 352 women presenting at a diabetes in pregnancy clinic at Westmead Hospital between 2019 and 2021 found 38.4% had MAFLD on FibroScan at 24-32 weeks gestation.

Presenting in the ADS President’s Young Investigator Award session at ADC 2021, Dr Thora Chai said controlled attenuation parameter (CAP) scores graded most affected women with MAFLD as having mild steatosis and no women had hepatic fibrosis based on a liver stiffness measure (LSM) ≥7.0 kPa.

Dr Chai said a significantly higher BMI was noted in the MAFLD group than the healthy liver group.

Women from the MAFLD group had higher systolic and diastolic blood pressures and were more likely to be on insulin therapy for their GDM. They also had higher fasting blood glucose levels.

Of the women who had liver function tests performed, a higher ALT was noted in women with MAFLD compared to women without MAFLD.

The study found only BMI and insulin therapy were independently associated with MAFLD, suggestive of more severe insulin resistance.

“In terms of adverse pregnancy outcomes, there was no significant difference between a composite of adverse maternal outcomes in women with or without MAFLD. However there was a trend towards a higher occurrence of adverse perinatal outcomes in women with MAFLD compared to women without.”

Dr Chai said when analysing the perinatal outcomes separately, a higher rate of neonatal high dependency unit admissions were observed in the MAFLD group.

She said a large proportion of neonates in the MAFLD group admitted to HDU were at high risk of developing neonatal hypoglycaemia and required further monitoring.

Dr Chai noted that given the limited use of FibroScan in the pregnant population, the CAP cut-off scores and LSM levels have not yet been validated. As well, the study was probably underpowered for detecting adverse outcomes.

However the findings were consistent with a recent systematic review and meta-analysis which found an increased risk of MAFLD in UK women with a previous history of GDM compared to no history of GDM (25.2% v 7.0%; OR 2.6).

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