Specific liver enzymes may build up at an accelerated rate in the decade after pregnancy for women who had gestational diabetes, increasing their odds of developing fatty liver compared with women who did not have gestational diabetes, according to findings published in the Journal of Diabetes.
“Early identification of individuals at high risk of altered glucose metabolism may provide an insight into the future risk of elevated fatty liver scores and potential subsequent downstream metabolic complications, which is pivotal for improving clinical outcomes for at-risk populations,” Cuilin Zhang, MD, PhD, MPH, a senior investigator in the epidemiology branch of the division of intramural population health research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the NIH in Bethesda, Maryland, and colleagues wrote. “Women with prior [gestational diabetes] have raised liver triglyceride levels, highlighting a potential link between [gestational diabetes] and liver dysfunction.”
Zhang and colleagues conducted follow-up examinations for 607 women with gestational diabetes (mean age during pregnancy, 31.6 years; mean time to follow-up, 12.7 years) and 619 women without the condition (mean age during pregnancy, 30.5 years; mean time to follow-up, 13.4 years) who took part in the Danish National Birth Cohort study from 1996 to 2002. Gestational diabetes was self-reported during the original study. According to the researchers, measures of three liver enzymes (plasma alanine aminotransferase, aspartate aminotransferase and gamma-glutamyl transferase) were collected during the follow-up examination and then used to calculate liver fat score, fatty liver index and hepatic steatosis index.
The researchers found that alanine aminotransferase was elevated by 6.7% (95% CI, 1.7-12) in women who had gestational diabetes compared with women who did not and that there was a 4.8% difference in aspartate aminotransferase (95% CI, 0.6-9.1) between the two groups as well. Although the difference in gamma-glutamyl transferase did not reach significance, compared with women who did not have gestational diabetes, women who did had 24.7% more liver fat by percentage (95% CI, 16.1-34), according to the researchers.
Specific liver enzymes may build up at an accelerated rate in the decade after pregnancy for women who had gestational diabetes, increasing their odds of developing fatty liver compared with women who did not have gestational diabetes.
The odds of having more liver fat were increased, based on a liver fat score of –0.64 or more, for women who had gestational diabetes compared with women who did not (RR = 2.34; 95% CI, 1.68-3.27). When using the fatty liver index, which identifies fatty liver with a score of at least 60, the researchers also found that women who had gestational diabetes had higher odds for developing the condition compared with women who did not have gestational diabetes (RR = 1.59; 95% CI, 1.27-1.99). In addition, the odds of having a hepatic steatosis index score of more than 36, which confirmed fatty liver, were also higher for women with gestational diabetes compared with women without gestational diabetes (RR = 1.44; 95% CI, 1.21-1.71).
The researchers further noted that there were higher odds for fatty liver for women who developed type 2 diabetes after pregnancy whether they had gestational diabetes (RR = 2.2; 95% CI, 1.56-3.11) or not (RR = 2.94; 95% CI, 1.78-4.86) compared with women who did not have any form of diabetes. A similar finding was observed when prediabetes developed after pregnancy in women who had gestational diabetes (RR = 2.79; 95% CI, 2.05-3.81) and women who did not (RR = 1.88; 95% CI, 1.18-3).
“Although, currently, examination of liver function in women of reproductive age is not standard, women with [gestational diabetes] may represent a high-risk population with liver abnormalities prior to pregnancy, which could be related to their development of [gestational diabetes],” the researchers wrote. “Gestational diabetes mellitus may potentially identify women at increased risk of these liver diseases earlier so that these women may benefit from early intervention.” – by Phil Neuffer
Disclosures: Zhang reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.