Rise in NAFLD in pregnancy has ‘huge national implications,’ highlights need for detection
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Key takeaways:
- Prevalence of NAFLD was 14% in pregnant women screened between 18 to 26 weeks of gestation, with less than 5% being previously evaluated.
- The highest prevalence was reported in Hispanic women with high BMI.
The prevalence of nonalcoholic fatty liver disease was 14% among pregnant women screened during early pregnancy, with fewer than 5% receiving prior evaluation for NAFLD, according to research in Clinical Gastroenterology and Hepatology.
“There has been a rise in NAFLD in women of childbearing age,” Tatyana Kushner, MD, MSCE, study author and associate professor of medicine in the division of liver diseases at Icahn School of Medicine at Mount Sinai, told Healio. “NAFLD is the leading cause of liver transplantation among women and the leading cause of cirrhosis among women during pregnancy.
“Furthermore, there has been emerging retrospective literature from the U.S. and Asia suggesting that there is an independent association between NAFLD in pregnancy with adverse pregnancy outcomes, such as gestational diabetes and hypertensive disorders of pregnancy.”
Kushner and colleagues on the multidisciplinary Fatty Liver in Pregnancy study team aimed to investigate the prevalence, predictors and clinical manifestations of NAFLD among pregnant women by conducting a prospective cohort study. The ultimate goal was to “understand the natural history of NAFLD in pregnant women and its implications on pregnancy outcomes and maternal health,” Kushner noted.
From December 2020 to January 2021, 540 pregnant adults (median age, 28 years) between 18 to 26 weeks gestation underwent a liver ultrasound at the time of their routine fetal anatomy scan. Experienced obstetric sonographers obtained four to six images of long and transverse views for each patient, which were de-identified and sent to a radiologist for blinded review for presence and grading of steatosis.
Researchers reported evidence of hepatic steatosis among 14% (95% CI, 11-17) of participants, with a prevalence of 19% among those of Hispanic race, 17% among those with a BMI of at least 25 and 20% among those with a BMI of 30 or greater. Of the 78 participants with evidence of steatosis, 83% (95% CI, 75-92) had grade 1, 14% (95% CI, 6-22) had grade 2 and 3% (95% CI, 0-6) had grade 3. Only 10 patients had steatosis previously identified via other imaging, and three had a diagnosis of NAFLD in their medical record.
“Fewer than 5% of individuals in our cohort had prior diagnosis of NAFLD,” Kushner said. “Pregnancy is an opportunity to identify women with NAFLD when they are engaged in care and link them to care.”
Results also showed that participants with steatosis in pregnancy were more likely to be Hispanic or from Mexico and less likely to be Black or from Africa (P < .05). They also had a higher median BMI vs. those without hepatic steatosis (29 kg/m2 vs. 23 kg/m2), with 79% having a BMI of at least 25.
“This has huge national implications,” Kushner said. “Around 500,000 women with NAFLD will have pregnancies annually in the U.S. We need to improve our understanding of how having NAFLD in pregnancy affects pregnancy outcomes, maternal health and fetal health.”
Univariate analysis demonstrated that pre-pregnancy BMI (OR = 1.06; 95% CI, 1.02-1.1), history of diabetes mellitus (OR = 4.52; 95% CI, 1.67-12.27), hypertension (OR = 2.31; 95% CI, 1.11-4.82), Hispanic ethnicity (OR = 2.59; 95% CI, 1.49-4.54) and history of gestational diabetes in prior pregnancy (OR = 2.81; 95% CI, 1.11-7.13) were “significantly associated” with steatosis in current pregnancy, while only BMI greater than 30 (OR = 1.98; 95% CI, 1.09-3.61) and Hispanic ethnicity (OR = 2.56; 95% CI, 1.31-5) were independently associated with steatosis in multivariate analysis.
Kushner noted that additional research is needed to better understand how NAFLD affects pregnancy outcomes and identify interventions to treat NAFLD during pregnancy and in the postpartum period and hopes these findings can highlight the importance of risk assessment and detection.
“Obstetricians and hepatologists can use our data to counsel patients on how common NAFLD is in pregnancy and to evaluate women for NAFLD who meet the risk profiles we identified,” she said. “Furthermore, given clear association with elevated BMI and NAFLD, care of women with NAFLD during pregnancy should incorporate counseling on health weight and gestational weight gain during pregnancy.”
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