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Metabolic dysfunction-associated fatty liver disease and subsequent development of adverse pregnancy outcomes

  • Seung Mi Lee
    Affiliations
    Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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  • Young Mi Jung
    Affiliations
    Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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  • Eun Saem Choi
    Affiliations
    Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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  • Soo Heon Kwak
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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  • Ja Nam Koo
    Affiliations
    Seoul Women's Hospital, Incheon, Korea
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  • Ig Hwan Oh
    Affiliations
    Seoul Women's Hospital, Incheon, Korea
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  • Byoung Jae Kim
    Affiliations
    Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea

    Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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  • Sun Min Kim
    Affiliations
    Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea

    Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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  • Sang Youn Kim
    Affiliations
    Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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  • Gyoung Min Kim
    Affiliations
    Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
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  • Sae Kyung Joo
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

    Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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  • Bo Kyung Koo
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

    Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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  • Sue Shin
    Affiliations
    Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea

    Department of Laboratory Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
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  • Errol R. Norwitz
    Affiliations
    Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, U.S.A.
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  • Chan-Wook Park
    Affiliations
    Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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  • Jong Kwan Jun
    Affiliations
    Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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  • Author Footnotes
    ∗ Both authors contributed equally to this work and serve as co-corresponding authors.
    Won Kim
    Correspondence
    Correspondence to: Won Kim, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea; Tel.: 82-2-870-2233; Fax: 82-2-831-2826
    Footnotes
    ∗ Both authors contributed equally to this work and serve as co-corresponding authors.
    Affiliations
    Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

    Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
    Search for articles by this author
  • Author Footnotes
    ∗ Both authors contributed equally to this work and serve as co-corresponding authors.
    Joong Shin Park
    Correspondence
    Correspondence to: Joong Shin Park, MD, PhD, Dept. of Obstetrics & Gynecology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Tel: 82-2-2072-3199; Fax: 82-2-762-3599
    Footnotes
    ∗ Both authors contributed equally to this work and serve as co-corresponding authors.
    Affiliations
    Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
    Search for articles by this author
  • Author Footnotes
    ∗ Both authors contributed equally to this work and serve as co-corresponding authors.
Published:November 16, 2021DOI:https://doi.org/10.1016/j.cgh.2021.11.007
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      ABSTRACT

      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 three 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 1,744 pregnant women, including 1,523 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. 3) 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.

      Graphical abstract

      Keywords

      Abbreviations:

      ALT (alanine aminotransferase), AST (aspartate aminotransferase), BMI (body mass index), ELISA (enzyme-linked immunosorbent assay), GDM (gestational diabetes mellitus), GGT (gamma-glutamyl transferase), HDL (high-density lipoprotein), HOMA-IR (homeostasis model assessment-insulin resistance), hs-CRP (high-sensitivity C-reactive protein), LGA (large-for-gestational age), MAFLD (metabolic dysfunction-associated fatty liver disease), MD (metabolic dysfunction), NAFLD (non-alcoholic fatty liver disease), SGA (small-for-gestational age), T2DM (type 2 diabetes mellitus), TG (triglyceride), WC (waist circumference)
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