Gestational Diabetes Mellitus Is Strongly Associated With... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTIONS: LIVER

Gestational Diabetes Mellitus Is Strongly Associated With Non-Alcoholic Fatty Liver Disease

Ajmera, Veeral H MD1; Gunderson, Erica P PhD2; VanWagner, Lisa B MD3; Lewis, Cora E MD4; Carr, John J MD5; Terrault, Norah A MD, MPH1

1Gastroenterology, University of California San Francisco, San Francisco, California, USA

2Division of Research, Kaiser Permanente Northern California, Oakland, California, USA

3Gastroenterology, Northwestern University, Chicago, Illinois, USA

4Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, Alabama, USA

5Department of Radiology, Vanderbilt University, Nashville, Tennessee, USA

Correspondence: Norah A. Terrault, MD, MPH, Division of Gastroenterology, University of California San Francisco, 521 Parnassus Avenue Box 0538 C-328, San Francisco, California 94143, USA. E-mail: [email protected]

SUPPLEMENTARY MATERIAL accompanies this paper at https://links.lww.com/AJG/A623

Received 01 October 2015; accepted 02 January 2016

Guarantor of the article: Veeral Ajmera, MD.

Specific author contributions: Veeral Ajmera: Data analysis, analytic plan, interpretation of results, manuscript authorship and review; Erica Gunderson: Data analysis, validation of pregnancy variables, analytic plan, interpretation of results and manuscript review; Lisa VanWagner: Analytic plan, interpretation of results, manuscript review; Cora Lewis: Manuscript review; John Carr: Funding, data acquisition, analysis, quality control, critical review of the text; Norah Terrault: Data analysis, analytic plan, interpretation of results, manuscript review.

Financial support: No direct financial sponsors for this project.

CARDIA is supported by the NHLBI. Analyses were supported by K01 and R01 grants to Dr Gunderson, T32 salary support for Dr Ajmera, R01 support for Dr Carr and AASLD grant for Dr VanWagner. The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham (HHSN268201300025C & HHSN268201300026C), Northwestern University (HHSN268201300027C), University of Minnesota (HHSN268201300028C), Kaiser Foundation Research Institute (HHSN268201300029C), and Johns Hopkins University School of Medicine (HHSN268200900041C). CARDIA is also partially supported by the Intramural Research Program of the National Institute on Aging. The analyses were supported by grants from K01 DK059944 (Dr Gunderson, PI), R01 DK090047 (Dr Gunderson, PI) and T32 5T32DK060414-13 (Dr Maher, PI) from the National Institute of Diabetes, Digestive and Kidney Diseases and R01 HL098445 (Dr Carr) from the National Heart, Lung, and Blood Institute. Dr VanWagner is supported by the American Association for the Study of Liver Diseases Foundation and the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number KL2TR001. Dr Veeral Ajmera is supported in part by an NIH funded postdoctoral research training program grant (T32 DK060414).

Potential competing interests: None.

Abstract

Objectives:

Insulin resistance is central to the development of non-alcoholic fatty liver disease (NAFLD), and gestational diabetes mellitus (GDM) is an early marker of insulin resistance. We hypothesized that a history of GDM would identify women at higher risk of NAFLD in middle age.

Methods:

Women from the multicenter Coronary Artery Risk Development in Young Adults (CARDIA) cohort study who delivered ≥1 birth, were free of diabetes prior to pregnancy(ies), and underwent CT quantification of hepatic steatosis 25 years following cohort entry (Y25: 2010–2011) were included ( n =1,115). History of GDM by self-report, validated in a subsample by review of antenatal glucose testing, and metabolic risk factors were assessed prospectively. NAFLD was defined by liver attenuation (LA)≤40 Hounsfield Units on CT scan after exclusion of other causes of hepatic steatosis.

Results:

Of 1,115 women meeting selection criteria (57% black, 43% white, median age 25 years at baseline), 124 (11%) reported a history of GDM and 75 (7%) met the CT definition for NAFLD at year 25. The crude risk of NAFLD at the 25-year visit was significantly higher in women with GDM compared to those without (14 vs. 5.8%, OR: 2.56, 95% CI: 1.44–4.55, P <0.01). History of GDM remained associated with NAFLD (OR: 2.29, 95% CI: 1.23–4.27, P =0.01) after adjustment for covariates in multivariable logistic regression. Addition of incident diabetes mellitus (DM) into the final model attenuated the association between GDM and NAFLD (OR: 1.48, 95% CI: 0.73–3.02, P =0.28). Conclusion: GDM is a risk marker for NAFLD and represents an opportunity to identify women at risk for NAFLD at a young age and may be mediated by the development of incident DM.