Exploring the relationship between metabolic dysfunction-associated fatty liver disease and gestational diabetes mellitus

Abstract

Introduction:

A bidirectional association likely exists between gestational diabetes mellitus (GDM) and metabolic dysfunction–associated fatty liver disease (MAFLD).

Aims:

This thesis aimed to determine the prevalence of MAFLD and its association with adverse pregnancy outcomes in women with GDM, and those at–risk of developing GDM, utilising transient elastography (FibroScan®) or non–invasive clinical indices (Hepatic Steatosis Index or HSI). Potential biomarkers in MAFLD and GDM were also explored.

Methods:

Six studies were conducted. A systematic review and meta–analysis explored the association between MAFLD and GDM whilst a retrospective cohort study assessed whether elevated HSI (>36) was associated with adverse pregnancy outcomes. MAFLD prevalence in women with GDM was determined with a cross–sectional cohort study, and whether it was a risk factor for GDM was assessed with a prospective cohort study. A prospective longitudinal cohort study investigated the progression of hepatic steatosis during pregnancy and serum biomarkers that were possibly shared or amplified in MAFLD and GDM.

Results:

MAFLD prevalence was 40% in women with GDM and those at–risk. MAFLD, detected via FibroScan® or elevated HSI (> 36), was associated with adverse maternal outcomes, primarily GDM development. Elevated HSI (> 36) may help in selecting at–risk women for further MAFLD screening with FibroScan®, although validation of selective screening is required. A more severe insulin–resistant phenotype was identified in women with MAFLD and GDM, however improvements in hepatic steatosis during pregnancy, particularly in women with GDM, were related to reduced gestational weight gain, suggesting lifestyle intervention can help manage both conditions.

Conclusions:

The adverse synergistic relationship between MAFLD and GDM warrants further exploration. This includes assessing whether MAFLD is associated with early GDM or an increased risk of postpartum cardiometabolic complications.