Gestational Diabetes Mellitus and Fatty Livers

Aiming to investigate the metabolic changes that occur before the onset of non-alcoholic fatty live disease (NAFLD) and type 2 diabetes, researchers found that insulin resistance and waist circumference were associated with NAFLD among women with previous gestational diabetes mellitus (pGDM).

Gestational diabetes mellitus (GDM) affects up to 9.2% of pregnancies in the US, according to the Centers for Disease Control and Prevention (CDC). Although it usually is resolved after a woman gives birth, a history of GDM carries risks. It doubles the risk of nonalcoholic fatty liver disease (NAFLD) and up to 70% of women with previous gestational diabetes mellitus (pGDM) may develop type 2 diabetes (T2D) over the long term, according to a recent Danish study.

Given these combined risk factors, the Danish researchers decided to study the presence of NAFLD in a cohort of overweight or obese women without diabetes but with pGDM. Their aim was to investigate the metabolic changes that occur before the onset of NAFLD and T2D.

What they found was that “…NAFLD is present in relatively young and not morbidly obese women with pGDM who are considered healthy apart from their increased risk for future diabetes. We also show that insulin resistance and waist circumference are independently and positively associated with the presence of ultrasound-defined NAFLD,” wrote the lead author, Tina Vilsboll MD, and her colleagues. Vilsboll is the director of the center for diabetes research and chief consultant endocrinologist at the department of medicine at Gentofte Hospital at the University of Copenhagen.

NAFLD is an accumulation of triglycerides in the liver and is the “most common” liver abnormality in the western world. In Europe it occurs in 20-33% of the adult population and 43 to 70% of T2D patients. It is a stealthy condition as in its mild to moderate forms without complications there is no abnormality in liver enzymes that show up in blood tests, Vilsboll and her co-authors explained. A liver biopsy is the gold-standard for detection, but ultrasound also is used.

The study’s results were obtained by following a cohort of 100 women without diabetes and pGDM over a five-year period. Twenty-four percent had both pGDM and NAFLD. The women with NAFLD had higher BMI (body mass index), larger waist circumference, increased insulin resistance, and delayed suppression of glucagon after an Oral Glucose Tolerence Test. They did not have a degree of glucose intolerance. There also were associations with more visceral fat mass and more total fat mass.

The study’s limitations included a small sample size and use of ultrasound rather than liver biopsy, they added.

The study was published online ahead of print in Diabetes Care on November 3.

Related Coverage:

The Enormous Cost of Nonalcoholic Fatty Liver Disease

Gestational Diabetes is a Risk Factor in Women’s Heart Disease

How to Test for Gestational Diabetes the Easy Way