Pre-pregnancy maternal obesity triples risk for fatty liver disease in offspring

A high maternal pre-pregnancy BMI increases the risk of offspring developing non-alcoholic fatty liver disease, according to findings presented at the 2021 International Liver Congress

“Maternal obesity is strongly associated with steatosis in offspring. Despite accounting for shared parental climate, this relationship does persist and that would support an early life effect and a role of the maternal-infant dyad in NAFLD pathogenesis,” Kushala Abeysekera, BSc, MBBS, said in the presentation. “It’s a reflection of the obesogenic environment our patients live in.”

To determine whether or not a high BMI increases an offspring’s risk of developing non-alcoholic fatty liver disease (NAFLD), the researchers used data from the Avon Longitudinal Study of Parents and Children (ALSPAC).

Offspring attended a clinic for FibroScan (Echosens) and CAP measurements using at the age of 24. The ALSPAC provided pre-pregnancy BMI data for both the maternal and paternal subjects. The paternal BMIs were used as a negative control test in the study.

Of the 4,021 original patients to attend the clinic, 2,961 had valid CAP scores analyzed. Subjects were removed from the study if they were from non-singleton pregnancies, consumed a harmful amount of alcohol, or did not attend the FibroScan clinic to provide necessary information.

ALSPAC previously showed that at age 24, one in five subjects had NAFLD. This study showed mothers with obesity had offspring that were three times more likely to develop NAFLD than those whose mothers were not obese. Additionally, subjects with obese fathers had an increased risk for developing NAFLD by the age of 24.

In those mothers had underweight, just 18.3% of offspring showed presence of NAFLD. When maternal weight fell into the overweight category, 39.6% had NAFLD, for an adjusted OR of 1.99 (95% CI, 1.54-2.57). When the weight levels fell into obesity, 41.3% of offspring had NAFLD, putting the OR at 3.19 (2.13-4.76).

“The presence of offspring steatosis increases as the pre-pregnancy maternal BMI increases,” Abeysekara said. “A similar trend is seen in terms of the presence of steatosis as paternal BMI increases to almost a third of participants having steatosis when their father had paternal obesity.”

When Abeysekera and colleagues looked at the paternal impact on offspring NAFLD, they found pre-pregnancy overweight linked to 23.3% of offspring having NAFLD with a crude OR of 1.39 (95% CI, 1.12-1.73). The presence of obesity then linked to 28.9% of offspring having NAFLD for a crude OR of 3.27 (1.26-3.72). When adjusted, paternal weight lost some of its impact, Abeysekera said.

“We see that the pre-pregnancy maternal BMI remains very strongly associated with outcomes of NAFLD in offspring whilst the paternal BMI relationship is attenuated,” Abeysekera said.