ODP247 The Detection of Metabolic Dysfunction–Associated Fatty Liver Disease via Fibroscan® in Early–to–Mid Pregnancy is an Independent Risk Factor for the Development of Gestational Diabetes Mellitus
Authors: Chai Thora Ying Li , Deng Difei , George Jacob , Pasupathy Dharmintra , Cheung Ngai Wah 
Published: November 2022

Abstract

Aims
To investigate whether the detection of metabolic dysfunction–associated fatty liver disease (MAFLD), formerly known as non–alcoholic fatty liver disease (NAFLD), in early–to–mid pregnancy is associated with the development of gestational diabetes mellitus (GDM).

Methods
A prospective longitudinal study was conducted on singleton pregnant women enrolled from a multiethnic obstetrics service in Sydney, Australia. A FibroScan ® was performed between 10–24 weeks to assess for hepatic steatosis in women with at least one risk factor for developing GDM, as per the Australasian Diabetes in Pregnancy Society (ADIPS) Guidelines 2014. A controlled attenuation parameter (CAP) score ≥233.5 dB/m was indicative of MAFLD, with severity graded as mild (Grade S1: CAP 233.5–267 dB/m), moderate (Grade S2: CAP 268–301 dB/m) and severe (Grade S3: CAP ≥302 dB/m). A liver stiffness measure (LSM) score ≥7. 0 kPa was indicative of hepatic fibrosis. Women were advised to fast for at least 2 hours prior to their FibroScan ® . GDM was determined by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) 2010 criteria, with a 75–gram oral glucose tolerance test (OGTT) performed between 24–28 weeks gestation. The cohort were separated by GDM status and categorical variables were compared with Pearson's chi–squared test or Fisher's exact test, and continuous variables with independent t-test or Mann–Whitney U test. Multiple logistic regression analysis was used to determine the independent predictors of GDM, reported as odds ratios (OR) and 95% confidence intervals (CI).

Results
Three–hundred and twenty–eight women were eligible for inclusion in our study. Of these, 135 (41.2%) had FibroScan ® –detected MAFLD, where 85 (25.9%) had Grade S1, 39 (11.9%) had Grade S2 and 11 (3.4%) had Grade S3. None of the women had hepatic fibrosis. Over 97% of women were fasting for at least 2 hours prior to their FibroScan ® . GDM was diagnosed in 87 (26.5%) women. A significantly higher rate of GDM were identified in women with MAFLD compared to those without (36.3% vs. 19.7%, p&lt;0. 01). Women with MAFLD were more likely obese, with pre–pregnancy body mass index (BMI) over 27.5kg/m 2 in Asians and over 30kg/m 2 in Europeans (58.5% vs. 12.4%, p&lt;0. 01), had an earlier diagnosis (prior to 24 weeks gestation) of GDM (8.1% vs. 1.6%, p&lt;0. 01) and administered insulin for treatment of their GDM (12.6% vs. 4.7%, p&lt;0. 01). After adjustment for ethnicity, pre–pregnancy BMI, prior history of GDM and a family history of diabetes, MAFLD remained an independent predictor of GDM development (adjusted OR 2.55, 95% CI 1.43–4.52, p&lt;0. 01).

Conclusions
The detection of MAFLD via FibroScan ® in early–to–mid pregnancy was an independent risk factor for the development of GDM. FibroScan ® is a quick and safe measure to help screen for MAFLD and may further aid in the risk stratification of women at–risk of developing GDM.
Presentation: No date and time listed