title: Non-Alcoholic Fatty Liver Disease in Early Pregnancy Predicts Dysglycemia in Mid-Pregnancy: Prospective Study.
abstract: Non-alcoholic fatty liver disease (NAFLD) is mediated by insulin resistance, as is gestational diabetes mellitus (GDM). NAFLD has not been studied in relation to GDM. The objective of this study was to assess the association between first-trimester sonographic findings of NAFLD, and both dysglycemia and GDM in mid-pregnancy.
  
  
  
  We followed a prospective cohort design at a large obstetrics clinic in Toronto, Ontario with 476 women enrolled in early pregnancy. NAFLD was assessed by ultrasound at 11-14 weeks gestation, and standardized images were independently scored by two ultrasonographers for the presence of hepatorenal contrast (one finding) and/or blurring of the intrahepatic vessels (one finding), relative to neither being present. Logistic regression analysis was used to generate odds ratios (ORs) and 95% confidence interval (CI) for the relation between 0, 1, or 2 sonographic findings of NAFLD and the composite outcome of impaired fasting glucose, impaired glucose tolerance, or GDM at 24-28 weeks gestation, determined by a fasting 75-g oral glucose tolerance test. ORs were adjusted (aOR) for maternal age, ethnicity, first-degree relative with type 2 DM, body mass index (BMI) at 11-14 weeks gestation, and change in BMI from 11-14 to 24-28 weeks gestation.
  
  
  
  Fifty out of 476 women (10.5%) developed the composite outcome. The presence of 1 (aOR 2.0, 95% CI: 1.0-4.1) or 2 (aOR 2.9, 95% CI: 1.0-18.4) sonographic features of NAFLD predicted the composite outcome. Limiting the analysis to ≥1 feature vs. none, the aOR was 2.2 (95% CI: 1.1-4.3).
  
  
  
  Sonographic assessment of NAFLD is a semiquantitative measure, with limited ability to detect small amounts of hepatic steatosis, or to distinguish various stages of NAFLD. First-trimester sonographic evidence of NAFLD predicts dysglycemia in mid-pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada.|Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Leanne R
authors.initials: LR
authors.lastname: De Souza
authors.affiliation: Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada.|Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Berger
authors.affiliation: Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Ravi
authors.initials: R
authors.lastname: Retnakaran
authors.affiliation: Department of Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Paraskevi A
authors.initials: PA
authors.lastname: Vlachou
authors.affiliation: Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Jonathon L
authors.initials: JL
authors.lastname: Maguire
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
authors.affiliation: Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada.|Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Philip W
authors.initials: PW
authors.lastname: Connelly
authors.affiliation: Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada.|Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.|Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, Ontario, Canada.|Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.|Department of Health Policy Management Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Joel G
authors.initials: JG
authors.lastname: Ray
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D018149:Glucose Intolerance / Q000175:diagnosis / Q000209:etiology*; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D016015:Logistic Models; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000000981:diagnostic imaging; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal
chemical_list: D000410:Alanine Transaminase