Evidence suggests the association between the non-alcoholic fatty liver disease (NAFLD) and impaired glucose homeostasis, however, the clinical significance of NAFLD in pregnant women is not well determined. A multicentre, prospective cohort study examined the relationship between NAFLD in the first trimester and the subsequent development of gestational diabetes mellitus (GDM).   

Singleton pregnant Korean women were enrolled in the study and assessed for NAFLD at 10–14 weeks utilising liver ultrasound, fatty liver index (FLI) and hepatic steatosis index (HSI). Measurements of Maternal plasma adiponectin and selenoprotein P concentrations were done. They were also screened for GDM using the two-step approach at 24–28 weeks. 

The following results were obtained-

• The final analysis included 608 women. 
• The prevalence of NAFLD was found to be 18.4%.  
• 5.9% developed GDM.  
• A higher prevalence of radiological steatosis (55.6% vs 16.1%) and higher FLI (40.0 vs 10.7) and HSI (35.5 vs 29.0) was noticed in Participants who developed GDM. 
• Participants with NAFLD had an increased risk of developing GDM and was positively associated with the severity of steatosis. 
• Even after adjustment for metabolic risk factors, including measures of insulin resistance the association between NAFLD and GDM remained significant. 
• Also, the correlation between maternal plasma adiponectin and selenoprotein P levels with NAFLD severity and the risk of developing GDM was found.

Thus, NAFLD in early pregnancy stands as an independent risk factor for GDM and Adiponectin may serve as a useful biomarker for foretelling GDM in pregnant women.

SOURCE- Lee SM, Kwak SH, Koo JN, Oh IH, Kwon JE, Kim BJ. et al. Non-alcoholic fatty liver disease in the first trimester and subsequent development of gestational diabetes mellitus. Diabetologia, 2019; 62:238–248 https://doi.org/10.1007/s00125-018-4779-8