title: Adverse outcomes of pregnancy in women with non-alcoholic fatty liver disease.
abstract: OBJECTIVE
  Non-alcoholic fatty liver disease (NAFLD) is considered the most common liver disease in the world, but little is known about its potential association with pregnancy outcomes. We aimed to investigate pregnancy outcomes in NAFLD.
  
  
  METHODS
  The Swedish Medical Birth Register (MBR) was used to identify births between 1992 and 2011 (N = 1 960 416). By linkage with the National Patient Register, we identified women with a diagnosis of NAFLD. The MBR was then used to identify outcomes: gestational diabetes, pre-eclampsia, Caesarean section, Apgar score <7 at 5 min, preterm birth (<37 weeks), low birth weight (<2500 g), infants born small for gestational age and congenital malformations. As controls, we used women with no diagnosis for NAFLD divided into two groups; with and without polycystic ovary syndrome (PCOS). Poisson regression was used to estimate relative risks (RRs) adjusted for maternal age, smoking status and body mass index at early pregnancy, parity and prepregnancy diabetes.
  
  
  RESULTS
  We identified 110 pregnancies in women with NAFLD. Using women without a diagnosis of NAFLD or PCOS as controls; NAFLD was associated with gestational diabetes [adjusted RRs 2.78; 95% confidence interval (CI): 1.25-6.15], pre-eclampsia (aRR 1.95; 95% CI 1.03-3.70), Caesarean section (aRR 1.52; 95% CI 1.19-1.94), preterm birth (aRR 2.50; 95% CI 1.38-4.55) and with low birth weight (aRR 2.40; 95% CI 1.21-4.78).
  
  
  CONCLUSIONS
  Women with a diagnosis of NAFLD prior to giving birth have increased risks for adverse pregnancy outcome independently of body mass index and diabetes, and should be carefully monitored during antenatal care.
authors.affiliation: Center for Digestive Diseases, Unit of Hepatology, Karolinska University Hospital, Institute of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Hannes
authors.initials: H
authors.lastname: Hagström
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jonas
authors.identifier: http://orcid.org/0000-0002-0012-1211
authors.initials: J
authors.lastname: Höijer
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
authors.forename: Jonas F
authors.initials: JF
authors.lastname: Ludvigsson
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bottai
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Institutet, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Ekbom
authors.affiliation: Center for Digestive Diseases, Unit of Hepatology, Karolinska University Hospital, Institute of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Rolf
authors.initials: R
authors.lastname: Hultcrantz
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Institutet, Stockholm, Sweden.|Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska University Hospital and Institutet, Stockholm, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Stephansson
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Institutet, Stockholm, Sweden.|Department of Medicine, Visby Hospital, Visby, Sweden.
authors.forename: Knut
authors.initials: K
authors.lastname: Stokkeland
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology; D013548:Sweden / Q000453:epidemiology
keywords: Caesarean section; epidemiology; gestational diabetes; pre-eclampsia; preterm birth; small for gestational age