Metabolic Dysfunction-Associated Fatty Liver Disease and Subsequent Development of Adverse Pregnancy Outcomes,Clinical Gastroenterology and Hepatology

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Metabolic Dysfunction-Associated Fatty Liver Disease and Subsequent Development of Adverse Pregnancy Outcomes
Clinical Gastroenterology and Hepatology ( IF 12.6 ) Pub Date : 2021-11-17 , DOI: 10.1016/j.cgh.2021.11.007
Seung Mi Lee ₁ , Young Mi Jung ₁ , Eun Saem Choi ₁ , Soo Heon Kwak ₂ , Ja Nam Koo ₃ , Ig Hwan Oh ₃ , Byoung Jae Kim ₄ , Sun Min Kim ₄ , Sang Youn Kim ₅ , Gyoung Min Kim ₆ , Sae Kyung Joo ₇ , Bo Kyung Koo ₇ , Sue Shin ₈ , Errol R Norwitz ₉ , Chan-Wook Park ₁ , Jong Kwan Jun ₁ , Won Kim ₇ , Joong Shin Park ₁

Affiliation

Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
Seoul Women's Hospital, Incheon, Korea.
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts.

Background & Aims

Recently, metabolic dysfunction–associated fatty liver disease (MAFLD), rather than nonalcoholic fatty liver disease (NAFLD), was proposed to better describe liver disease associated with metabolic dysfunction (MD). In this study, we attempted to investigate the impact of MAFLD on pregnancy complications.

Methods

The current study is a secondary analysis of a multicenter prospective cohort designed to examine the risk of NAFLD during pregnancy. In the first trimester, enrolled pregnant women were evaluated for hepatic steatosis by liver ultrasonography, and blood samples were collected for biochemical measurements. The study population was divided into 3 groups: no NAFLD, hepatic steatosis but without metabolic dysfunction (non-MD NAFLD), and MAFLD. The primary outcome was the subsequent development of adverse pregnancy outcomes, including gestational diabetes mellitus, pregnancy-associated hypertension, preterm birth, and fetal growth abnormalities.

Results

The study population consisted of 1744 pregnant women, including 1523 with no NAFLD, 43 with non-MD NAFLD, and 178 with MAFLD. The risk of subsequent development of adverse pregnancy outcomes was higher in MAFLD than in non-MD NAFLD (adjusted odds ratio, 4.03; 95% CI, 1.68–9.67), whereas the risk was not significantly different between no NAFLD and non-MD NAFLD. Among women with no NAFLD, the presence of MD increased the risk of adverse pregnancy outcomes. However, women with MAFLD were at higher risk for adverse pregnancy outcomes than women with no NAFLD without MD or those with no NAFLD with MD.

Conclusions

In pregnant women, MAFLD may be associated with an increased risk of subsequent adverse pregnancy outcomes.

中文翻译：

代谢功能障碍相关的脂肪肝疾病和不良妊娠结局的后续发展

背景与目标

最近，提出了代谢功能障碍相关的脂肪肝疾病（MAFLD），而不是非酒精性脂肪肝疾病（NAFLD），以更好地描述与代谢功能障碍（MD）相关的肝病。在这项研究中，我们试图调查 MAFLD 对妊娠并发症的影响。

方法

目前的研究是对多中心前瞻性队列的二次分析，旨在检查妊娠期间 NAFLD 的风险。在孕早期，通过肝脏超声检查对纳入的孕妇进行肝脏脂肪变性评估，并收集血液样本进行生化检测。研究人群分为 3 组：无 NAFLD、肝脂肪变性但无代谢功能障碍（非 MD NAFLD）和 MAFLD。主要结局是随后发生的不良妊娠结局，包括妊娠期糖尿病、妊娠相关性高血压、早产和胎儿生长异常。

结果

研究人群由 1744 名孕妇组成，其中 1523 名没有 NAFLD，43 名患有非 MD NAFLD，178 名患有 MAFLD。MAFLD 患者随后发生不良妊娠结局的风险高于非 MD NAFLD（调整优势比，4.03；95% CI，1.68-9.67），而无 NAFLD 和非 MD NAFLD 的风险无显着差异. 在没有 NAFLD 的女性中，MD 的存在增加了不良妊娠结局的风险。然而，MAFLD 女性的不良妊娠结局风险高于无 NAFLD 且无 MD 的女性或无 NAFLD 且有 MD 的女性。