title: Hepatic steatosis is prevalent in stillborns delivered to women with diabetes mellitus.
abstract: OBJECTIVE
  Maternal diabetes is a risk factor for pregnancy complications, including stillbirth and macrosomia. Evolving data suggest that diabetes during pregnancy also has long-term consequences for offspring, putting them at risk for obesity and the metabolic syndrome in childhood. Because nonalcoholic fatty liver disease is known to occur in adults and children with insulin resistance, we hypothesized that altered lipid metabolism in fetuses of diabetic mothers may manifest with hepatic steatosis.
  
  
  METHODS
  We undertook a retrospective autopsy study to compare the presence and degree of hepatic steatosis between stillborns delivered to women with pregestational or gestational diabetes mellitus (gestational age 20-40 weeks; n = 33) and age-matched nondiabetic control stillbirth cases (n = 48), the latter enriched for maternal obesity, macrosomia, and similar cause of demise.
  
  
  RESULTS
  Histopathologic hepatic steatosis was significantly more prevalent and severe in the diabetic subjects (26/33, 78.8%) than in the controls (8/48, 16.6%) (P < 0.001). Within the diabetic cohort, the severity of steatosis was related directly to gestational age, birth weight, and liver weight, with no correlation of presence or severity of steatosis in the control group to maternal or fetal factors, including maternal body mass index or fetal macrosomia. Although macrosomic stillborns were more common in diabetic women with %hemoglobin A1c >6 and body mass index >30 kg/m, fetal steatosis was independent of glycemic control, maternal obesity, type of diabetes, ethnicity, or fetal sex in our cohort.
  
  
  CONCLUSIONS
  This study is the first to our knowledge to demonstrate a specific association between fetal hepatic steatosis and maternal diabetes.
authors: *Department of Laboratories, Seattle Children's Hospital and University of Washington, Seattle †Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO.
authors: Kalyani R
authors: KR
authors: Patel
authors: Frances V
authors: FV
authors: White
authors: Gail H
authors: GH
authors: Deutsch
mesh_terms: D001724:Birth Weight; D016022:Case-Control Studies; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005234:Fatty Liver / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology* / Q000473:pathology; D005865:Gestational Age; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D009929:Organ Size; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D050497:Stillbirth