Hepatology

MAFLD present in one in four women with GDM


Metabolic associated fatty liver disease (MAFLD) has been identified in more than a quarter of pregnant women with gestational diabetes in an Australian study.

NSW researchers made the findings in 108 women attending an obstetrics clinic, who had transient elastography (TE) after 24 weeks gestation with a diagnosis of GDM established on a 75-gram oral glucose tolerance test.

The women were from a multiethnic population in Sydney with just over half the cohort (53%) from South Asian countries such as India and Pakistan and a further 22% from Southeast Asian countries such as China and the Philippines.

Based on a FibroScan TE assessment CAP cut-off score ≥ 233.5 dB/m indicating the presence of hepatic steatosis, 26.9% of women had MAFLD.

The study, published in Diabetes Research and Clinical Practice, found 16.7% of women had mild steatosis, 8.3% had moderate steatosis and 1.9% had severe grade steatosis. No hepatic fibrosis was detected.

The study found only increased maternal BMI was associated with a diagnosis of MAFLD.

“The current study is one of the largest studies to date specifically examining for MAFLD in women with established GDM in the later stages of pregnancy and is also one of the first to utilise FibroScan for this purpose,” the study said.

“In contrast to previous studies, our study cohort was from a multiethnic population, and in particular comprised a high proportion of women of South Asian origin (52.8%).”

The researchers, including Professor Jacob George from the Storr Liver Centre and Professor N Wah Cheung from the Centre for Diabetes & Endocrinology Research at Westmead, said when compared to other studies, their findings showed no dramatic interethnic variations in the association between GDM and MAFLD.

They also noted the relationship between elevated BMI and MAFLD seen in the study was consistent with the well-established link between MAFLD and obesity in the general population.

“This association remained significant after adjustment for other measures including maternal age, gravidity, blood pressure and the requirement of insulin,” the study said.

“Whilst there is currently no intervention beyond appropriate weight and GDM management for these women, the detection of MAFLD during pregnancy may present an opportunity for early education and long-term lifestyle changes to prevent progression of MAFLD and the development of type 2 diabetes in later life,” they concluded.

They said FibroScan was a safe, practical and relatively quick assessment method for screening women during pregnancy.

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