518: The risk of pregnancy-associated hypertension in pregnant women with nonalcoholic fatty liver disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a risk factor for cardiovascular diseases in later life. Although the biologic mechanism is not well understood, it likely involves metabolic factors, inflammatory reactions, and endothelial dysfunction, all of which are known pathophysiologic factors in the development of pregnancy- associated HTN, including preeclampsia. However, the risk of pregnancy-associated HTN in pregnant women with NAFLD has not been well established. This study examines the risk of pregnancy-associated HTN in pregnant women with NAFLD. This is a secondary analysis of a large prospective cohort study of healthy Korean women with a singleton pregnancy designed to examine the risk of gestational diabetes in women with NAFLD. Liver ultrasound was performed in all cases at 10-14 weeks of gestation and the degree of hepatic steatosis classified as Grade 0-3. At the time of liver ultrasound, maternal blood was taken and measured for selenoprotein P, a hepatokine that has been independently associated with NAFLD and cardiovascular disease. Pregnancy-associated HTN was defined as the development of gestational hypertension, preeclampsia, or eclampsia. Among 877 enrolled subjects, the risk of pregnancy-associated HTN increased significantly in patients with NAFLD (Fig 1). Grade 2-3 steatosis at 10-14 weeks was a significant risk factor for the development of pregnancy- associated HTN, even after adjustment for metabolic risk factors (BMI, fasting glucose). The concentration of selenoprotein P was significantly higher in women with NAFLD vs those without NAFLD at 10-14 weeks (p=0.001), and was also significantly increased in women who subsequently developed pregnancy-associated HTN vs those that did not (p<0.001) (Fig 2). Sonographic evidence of NAFLD at 10-14 weeks is an independent risk factor for pregnancy- associated HTN. Circulating selenoprotein P levels are increased in patients with NAFLD, which may be linked to the development of pregnancy-associated HTN.View Large Image Figure ViewerDownload Hi-res image Download (PPT)