Jung Young Mi, Lee Seung Mi, Wi Wonyoung, Oh Min-Jeong, Park Joong Shin, Cho Geum Joon, Kim Won
Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
JHEP Rep. 2024 Feb 23;6(4):101033. doi: 10.1016/j.jhepr.2024.101033. eCollection 2024 Apr.
BACKGROUND & AIMS: Adverse pregnancy outcomes (APOs) can worsen cardiometabolic risk factors in women, raising their likelihood of developing cardiometabolic diseases at a young age after their initial pregnancy. Nevertheless, there are limited data on the risk of newly developing metabolic dysfunction-associated steatotic liver disease (MASLD) in women who have had APOs. This study aimed to evaluate the risk of new-onset MASLD after experiencing APOs.
Singleton pregnant women who underwent national health screenings 1 year before pregnancy and 1 year after delivery were included in this study. APOs were defined as the presence of at least one of the followings: hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), preterm birth, low birth weight, and placental abruption. The primary outcome was new-onset MASLD based on the presence of APOs.
Among 80,037 study participants, 9,320 (11.6%) experienced APOs during pregnancy. Women who experienced APOs had an increased risk of developing new-onset MASLD after delivery even after adjustments for various covariates (adjusted odds ratio [OR] 1.58, 95% CI 1.45-1.72). In particular, women who experienced either HDP or GDM showed a significantly increased risk of developing new-onset MASLD (adjusted OR 2.20, 95% CI 1.81-2.67, for HDP and adjusted OR 1.83, 95% CI 1.65-2.03, for GDM). Moreover, there was a tendency toward an increased risk of new-onset MASLD according to the number of APOs ( <0.001 for trend of odds).
APOs were associated with the risk of new-onset MASLD after delivery. Specifically, only HDP or GDM were identified as risk factors for new-onset MASLD.
This nationwide cohort study confirms that postpartum women with a history of adverse pregnancy outcomes (APOs) are at an increased risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD). These findings may bring us one step closer to understanding the exact mechanisms underlying such an important association between prior APOs and cardiovascular disease (CVD) risk among postpartum women. This bidirectional association between APOs and MASLD highlights the importance of considering pregnancy history in assessing CVD risk in women. It suggests a need for closer monitoring and lifestyle interventions for women with a history of APOs to reduce the risk of MASLD and subsequent CVD complications.
不良妊娠结局（APO）会使女性的心血管代谢危险因素恶化，增加其在首次怀孕后年轻时患心血管代谢疾病的可能性。然而，关于有APO的女性新发生代谢功能障碍相关脂肪性肝病（MASLD）风险的数据有限。本研究旨在评估经历APO后新发MASLD的风险。
本研究纳入了在怀孕前1年和分娩后1年接受国家健康筛查的单胎孕妇。APO被定义为存在以下至少一项：妊娠高血压疾病（HDP）、妊娠期糖尿病（GDM）、早产、低出生体重和胎盘早剥。主要结局是基于APO的存在情况新发MASLD。
在80,037名研究参与者中，9,320名（11.6%）在孕期经历了APO。即使在对各种协变量进行调整后，经历APO的女性在分娩后发生新发MASLD的风险仍增加（调整后的比值比[OR]为1.58，95%置信区间为1.45 - 1.72）。特别是，经历HDP或GDM的女性发生新发MASLD的风险显著增加（HDP的调整后OR为2.20，95%置信区间为1.81 - 2.67；GDM的调整后OR为1.83，95%置信区间为1.65 - 2.03）。此外，根据APO的数量，新发MASLD的风险有增加的趋势（比值比趋势<0.001）。
APO与分娩后新发MASLD的风险相关。具体而言，仅HDP或GDM被确定为新发MASLD的危险因素。
这项全国性队列研究证实，有不良妊娠结局（APO）病史的产后女性发生代谢功能障碍相关脂肪性肝病（MASLD）的风险增加。这些发现可能使我们更接近了解先前APO与产后女性心血管疾病（CVD）风险之间这种重要关联的确切机制。APO与MASLD之间的这种双向关联凸显了在评估女性CVD风险时考虑妊娠史的重要性。这表明需要对有APO病史的女性进行更密切的监测和生活方式干预，以降低MASLD及随后CVD并发症的风险。
