(325) Metabolic dysfunction-associated steatotic liver disease is associated with glucose intolerance in pregnancy

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) comprises ultrasound-identified steatotic liver disease (SLD) along with cardiometabolic risk factors. Retrospective data suggests MASLD is independently associated with gestational diabetes (GDM). While both MASLD and GDM have implications for long-term maternal health outcomes, prospective research on MASLD in pregnancy is limited. The objective of this study was to prospectively determine the association between MASLD and GDM.

Study Design: A prospective cohort of pregnant individuals (n=916) were assessed for MASLD and obstetrical outcomes. During obstetrical sonogram at 18-22 weeks for enrolled participants, images of the maternal liver were captured and evaluated by a radiologist for the presence and grading of SLD. GDM was diagnosed using ACOG guidelines. Logistic regression models evaluated the association of presence and severity of MASLD with GDM.

Results: High grade SLD (grade 2-3) was identified in 34 (4%) patients. The median (IQR) age was 29 (8); Most participants self-identified as Black race (41%) and/or Hispanic ethnicity (48%). 87% of SLD patients met criteria for MASLD with BMI ≥25.  A total of 182 (22%) of participants screened positive (≥140 mg/dL) on a 1-hour glucose challenge test (GCT) and 107 (12%) were diagnosed with GDM. Patients with Grade 2/3 SLD were more likely to be of Hispanic ethnicity, have BMI≥25, and screen positive on GCT (p < 0.01)(Table 1). In unadjusted analyses, high grade SLD was associated with GDM (OR 1.8 [0.7-4.1]) and positive GCT (OR 4.0 [1.8-8.7]). In multivariate linear regression analyses controlling for age and BMI, the association between SLD and GDM was attenuated (p >0.05).

Conclusion: Findings from a large, diverse, prospective cohort illustrate altered glucose metabolism with advanced steatosis. This effect was attenuated by BMI and age. Early screening for GDM in patients with hepatic steatosis should be considered. Pregnancy represents an ideal window for MASLD screening, and research into future metabolic health following a diagnosis of MASLD/SLD in pregnancy is needed.