title: Gestational Diabetes Mellitus Is Strongly Associated With Non-Alcoholic Fatty Liver Disease.
abstract: Insulin resistance is central to the development of non-alcoholic fatty liver disease (NAFLD), and gestational diabetes mellitus (GDM) is an early marker of insulin resistance. We hypothesized that a history of GDM would identify women at higher risk of NAFLD in middle age.
  
  
  
  Women from the multicenter Coronary Artery Risk Development in Young Adults (CARDIA) cohort study who delivered ≥1 birth, were free of diabetes prior to pregnancy(ies), and underwent CT quantification of hepatic steatosis 25 years following cohort entry (Y25: 2010-2011) were included (n=1,115). History of GDM by self-report, validated in a subsample by review of antenatal glucose testing, and metabolic risk factors were assessed prospectively. NAFLD was defined by liver attenuation (LA)≤40 Hounsfield Units on CT scan after exclusion of other causes of hepatic steatosis.
  
  
  
  Of 1,115 women meeting selection criteria (57% black, 43% white, median age 25 years at baseline), 124 (11%) reported a history of GDM and 75 (7%) met the CT definition for NAFLD at year 25. The crude risk of NAFLD at the 25-year visit was significantly higher in women with GDM compared to those without (14 vs. 5.8%, OR: 2.56, 95% CI: 1.44-4.55, P<0.01). History of GDM remained associated with NAFLD (OR: 2.29, 95% CI: 1.23-4.27, P=0.01) after adjustment for covariates in multivariable logistic regression. Addition of incident diabetes mellitus (DM) into the final model attenuated the association between GDM and NAFLD (OR: 1.48, 95% CI: 0.73-3.02, P=0.28).
  
  
  
  GDM is a risk marker for NAFLD and represents an opportunity to identify women at risk for NAFLD at a young age and may be mediated by the development of incident DM.
authors.affiliation: Gastroenterology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Veeral H
authors.initials: VH
authors.lastname: Ajmera
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
authors.forename: Erica P
authors.initials: EP
authors.lastname: Gunderson
authors.affiliation: Gastroenterology, Northwestern University, Chicago, Illinois, USA.
authors.forename: Lisa B
authors.initials: LB
authors.lastname: VanWagner
authors.affiliation: Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, Alabama, USA.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: Gastroenterology, University of California San Francisco, San Francisco, California, USA.
authors.forename: Norah A
authors.initials: NA
authors.lastname: Terrault
mesh_terms: D000328:Adult; D015331:Cohort Studies; D048909:Diabetes Complications / Q000150:complications*; D016640:Diabetes, Gestational; D005260:Female; D006801:Humans; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology*; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult