March 15, 2016
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NAFLD in early pregnancy predicts risk for diabetes, dysglycemia mid-pregnancy

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Sonographic evidence of nonalcoholic fatty liver disease in early pregnancy predicted the risk for developing gestational diabetes and dysglycemia mid-pregnancy, according to the findings of a prospective cohort study.

Joel G. Ray, MD, MSc, FRCPC, of the department of medicine and obstetrics and gynecology, St. Michael’s Hospital, University of Toronto, and colleagues evaluated 476 healthy women in early pregnancy enrolled at an obstetrics clinic within St. Michael’s Hospital in Toronto, Ontario. Each patient underwent ultrasound between 11 and 14 weeks’ gestation to assess NAFLD. Further, standardized images were independently scored by two ultrasonographers for the presence of hepatorenal contrast or blurring of the intrahepatic vessels.

“We hypothesized that women with sonographic evidence of hepatic fat in early pregnancy would exhibit dysglycemia and [gestational diabetes mellitus] in the second trimester, even after adjusting for [BMI],” the researchers wrote. “We also evaluated whether an elevated [alanine aminotransferase level] in the second trimester of pregnancy was associated with dysglycemia and [gestational diabetes mellitus] in the second trimester of pregnancy.”

Overall, 10.5% (n = 50) of the patients developed composite gestational diabetes mellitus, impaired fasting glucose or impaired glucose tolerance. The presence of one sonographic feature of hepatic fat (adjusted [a]OR = 2; 95% CI, 1–4.1) or two (aOR = 2.9; 95% CI, 1–18.4) predicted the composite outcome even after adjusting for specific covariates. When limiting the analysis to more than one feature compared with zero features, the aOR was 2.2 (95% CI, 1.1–4.3).

Fifteen percent of women (n =71) had hepatorenal contrast, 1.3% (n = 6) had blurring hepatic vessels and 1.3% (n = 6) had both on ultrasound.

The researchers concluded: “We efficiently measured NAFLD by ultrasonography in early pregnancy, coinciding with a routine first trimester ultrasonography. … First-trimester sonographic evidence of NAFLD predicts dysglycemia in mid-pregnancy.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.