代谢功能障碍相关脂肪性肝病的流行及其与妊娠糖尿病女性不良妊娠结局的关系。
The prevalence of metabolic dysfunction-associated fatty liver disease and its association on adverse pregnancy outcomes in women with gestational diabetes mellitus.
机构信息
Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
出版信息
Diabetes Res Clin Pract. 2022 Sep;191:110038. doi: 10.1016/j.diabres.2022.110038. Epub 2022 Aug 13.
AIMS
To determine the prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and its association on adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM).
METHODS
380 women with GDM had a FibroScan® performed between 24 and 32 weeks. A Controlled Attenuation Parameter (CAP) ≥ 233.5 dB/m signified MAFLD. Gestational hypertension, pre-eclampsia and eclampsia contributed to a composite of adverse maternal outcomes. A composite of adverse neonatal outcomes included pre-term birth, hypoglycaemia, small/large-for-gestational age and admission to neonatal high dependency. Multiple logistic regression was used to determine independent associations with MAFLD.
RESULTS
147 (38.7 %) women had MAFLD. Higher pre-pregnancy BMI (median 28.4, IQR 24.7-33.0 kg/m vs median 24.0, IQR 21.7-26.5 kg/m, p < 0.01) and rates of insulin therapy (62.2 % vs 40.7 %, p < 0.01) occurred in MAFLD over non-MAFLD women. MAFLD was independently associated with obesity (aOR 4.73 [95 % CI 2.53-8.86]) and insulin therapy (aOR 1.79 [95 % CI 1.12-2.85]). MAFLD and non-MAFLD women had comparable rates of adverse maternal (7.7 % vs 9.5 %, p = 0.56) and neonatal outcomes (75.4 % vs 68.8 %, p = 0.18).
CONCLUSIONS
Within this GDM cohort, almost 40% had FibroScan®-detected MAFLD in mid-to-late gestation. MAFLD was not associated with worse pregnancy outcomes.
目的
确定代谢功能障碍相关脂肪性肝病（MAFLD）在患有妊娠期糖尿病（GDM）的女性中的流行率及其与不良妊娠结局的关系。
方法
380 名 GDM 女性在 24 至 32 周之间进行了 FibroScan®检查。受控衰减参数（CAP）≥233.5dB/m 表示 MAFLD。妊娠高血压、先兆子痫和子痫导致了不良母亲结局的综合表现。不良新生儿结局的综合表现包括早产、低血糖、小于胎龄儿或大于胎龄儿以及新生儿高依赖病房入院。多变量逻辑回归用于确定与 MAFLD 相关的独立因素。
结果
147 名（38.7%）女性患有 MAFLD。MAFLD 女性的孕前 BMI 更高（中位数 28.4，IQR 24.7-33.0kg/m 与中位数 24.0，IQR 21.7-26.5kg/m，p<0.01），胰岛素治疗率（62.2%比 40.7%，p<0.01）也更高。MAFLD 与肥胖（优势比 4.73 [95%置信区间 2.53-8.86]）和胰岛素治疗（优势比 1.79 [95%置信区间 1.12-2.85]）独立相关。MAFLD 和非 MAFLD 女性的不良母亲（7.7%比 9.5%，p=0.56）和新生儿结局（75.4%比 68.8%，p=0.18）的发生率相当。
结论
在这个 GDM 队列中，近 40%的女性在妊娠中期到晚期通过 FibroScan®检测出 MAFLD。MAFLD 与妊娠结局恶化无关。
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