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Abstract Details
Non-alcoholic Fatty Liver Disease in Pregnancy Is Associated With Adverse Maternal and Perinatal Outcomes
J Hepatol. 2020 Apr 15;S0168-8278(20)30215-4. doi: 10.1016/j.jhep.2020.03.049.Online ahead of print.
Monika Sarkar1, Joshua Grab2, Jennifer L Dodge3, Erica P Gunderson4, Jessica Rubin5, Roxanna A Irani6, Marcelle Cedars7, Norah Terrault8
Author information
1University of California, San Francisco, Division of GI/Hepatology. Electronic address: monika.sarkar@ucsf.edu.
2University of California San Francisco, Department of Surgery. Electronic address: joshua.grab@ucsf.edu.
3University of California San Francisco, Department of Surgery. Electronic address: jennifer.dodge@ucsf.edu.
4Kaiser Permanente Division of Research. Electronic address: Erica.gunderson@kp.og.
5University of California, San Francisco, Division of GI/Hepatology. Electronic address: jessica.rubin@ucsf.edu.
6University of California, San Francisco, Department of Obstetrics and Gynecology. Electronic address: roxanna.irani@ucsf.edu.
7University of California, San Francisco, Department of Obstetrics and Gynecology. Electronic address: marcelle.cedars@ucsf.edu.
8University of California, San Francisco, Department of Obstetrics and Gynecology; University of Southern California, Division of GI/Hepatology. Electronic address: norah.terrault@usc.edu.
Abstract
Aims & background: Non-alcoholic fatty liver disease (NAFLD) is rising in young adults, with potential implications for reproductive-aged women. Whether NAFLD during pregnancy confers more serious risks for maternal or perinatal health is unclear.
Methods: Using weighted discharge data from the United States National Inpatient Sample, we evaluated temporal trends of NAFLD in pregnancies after 20 weeks gestation, and compared outcomes to pregnancies with other chronic liver diseases (CLD) or no CLD. Study outcomes included pre-term birth, postpartum hemorrhage, hypertensive complications (pre-eclampsia, eclampsia, and/or hemolysis, elevated liver enzymes, and low platelets syndrome), and maternal or fetal death. NAFLD prevalence was estimated by calendar year and temporal trends tested by linear regression. Outcomes were analyzed by logistic regression adjusted for age, race, multiple gestation, and pre-pregnancy diabetes, obesity, dyslipidemia and hypertension.
Results: Among 18,574,225 pregnancies, 5,640 had NAFLD and 115,210 had other, non-NAFLD CLD. Pregnancies with NAFLD nearly tripled from 10.5/100,000 pregnancies in 2007 to 28.9/100,000 in 2015 (p<.001). NAFLD versus other groups had more gestational diabetes (23% vs 7-8%), hypertensive complications (16% vs 4%), postpartum hemorrhage (6 vs 3-5%), and pre-term birth (9% vs 5-7%), p values < 0.01. On adjusted analysis, compared to no CLD, NAFLD was associated with hypertensive complications (OR 3.1, 95% CI 2.6-3.8, p<.001), pre-term birth (OR 1.6, 95% CI 1.3-2.0, p<.001), postpartum hemorrhage (OR 1.7, 95% CI 1.3-2.2) and possibly maternal (OR 17.8, 95% CI 2.1-149 p=.01), but not fetal death (p=.90).
Conclusion: NAFLD in pregnancy has nearly tripled in the last decade and is independently associated with hypertensive complications, postpartum hemorrhage and pre-term birth. NAFLD should be considered a high-risk obstetric condition, with clinical implications for pre-conception counseling and pregnancy care.