Metabolic Dysfunction-Associated Steatotic Liver Disease in Pregnancy: A Review.

Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are the predominant pregnancy complications among singleton and twin pregnancies worldwide. Our primary objective was to explore the adverse effect of GDM and HDP on maternal-perinatal outcomes compared with non-GDM and non-HDP in singleton and twin pregnancies. The secondary objective was to find the risk of adverse maternal-perinatal outcomes in twin pregnancies compared with singleton pregnancies complicated with GDM and HDP in Hubei, China. A tertiary hospital-based retrospective study was conducted at Wuhan University Renmin Hospital, Hubei Province, China, from 2011 to 2019. A chi-square test was used to determine the difference in adverse maternal-perinatal outcomes between singleton and twin pregnancies. A multiple binary logistic regression model and a joinpoint regression model were used to determine the association of GDM and HDP with adverse maternal-perinatal outcomes and GDM and HDP temporal trend among singleton and twin pregnancies. The trend of HDP [average annual percentage change (AAPC) 15.1% (95% confidence interval (95%CI): 5.3, 25.7)] among singleton pregnancies and GDM [AAPC 50.4% (95%CI: 19.9, 88.7)] among twin pregnancies significantly increased from 2011 to 2019. After adjusting for confounding factors, GDM is associated with an increased risk of C-section (adjusted odds ratio (aOR), 1.5; 95%CI: 1.3, 1.6) and macrosomia (aOR, 1.3; 95%CI: 1.1, 1.6) in singleton and preterm birth (PTB) (aOR, 2.1; 95%CI: 1.2, 3.3) in twin pregnancies compared with non-GDM. HDP was associated with a higher risk of C-section, PTB, perinatal mortality, and low birth weight (LBW) in both singleton and twin pregnancies compared with the non-HDP. Compared with singleton pregnancies complicated with GDM and HDP, twin pregnancies showed higher odds of C-section [(aOR, 1.7; 95%CI: 1.1, 2.7), (aOR, 4.6; 95%CI: 2.5, 8.7), respectively], PTB [(aOR, 22.9; 95%CI: 14.1, 37.3), (aOR, 8.1; 95%CI: 5.3, 12.3), respectively], LBW [(aOR, 12.1; 95%CI: 8.2, 18.1), (aOR, 5.1; 95%CI: 3.6, 7.4), respectively], and low Apgar score [(aOR, 8.2; 95%CI: 4.4, 15.1), (aOR, 3.8; 95%CI: 2.4, 5.8), respectively] complicated with GDM and HDP. In conclusion, GDM showed an increased risk of a few adverse maternal-perinatal outcomes and HDP is associated with a higher risk of several adverse maternal-perinatal outcomes in singleton and twin pregnancies compared to non-GDM and non-HDP. Moreover, twin pregnancies complicated with GDM and HDP showed higher odds of adverse maternal-neonatal outcomes compared with singleton pregnancies complicated with GDM and HDP.

The simultaneous occurrence of gestational diabetes and hypertensive disorders of pregnancy affects fetal growth and neonatal morbidity

NAFLD vs. MAFLD – It is not the name but the disease that decides the outcome in fatty liver

Background: Hypertensive disorders of pregnancy and gestational diabetes (GDM) are all associated with increased risks of poor maternal and perinatal outcomes. It has been hypothesized that the association could be due to at least in part, to insulin resistance. Although insulin resistance is a physiologic phenomenon in normal pregnancy, in predisposed individuals it could lead to hyper-insulinemia with development of GDM, hypertensive disorders of pregnancy (gestational hypertension, pre-eclampsia and eclampsia) or both. In the present study the role of insulin resistance in early prediction of gestational diabetes mellitus and hypertensive disorders in pregnancy. Researchers attempted to study the correlation of insulin resistance at 11 to 14 weeks period of gestation and outcome in terms of GDM and hypertensive disorders in pregnancy and explore the possible use of insulin resistance in their early prediction. Objectives: Prediction of gestational diabetes mellitus and hypertensive disorders in pregnancy using insulin resistance at 11-14 weeks of gestation. To evaluate if combined maternal markers (insulin resistance, mean arterial pressure and uterine artery Doppler pulsatility index) in first trimester of pregnancy (11-14 weeks) is more effective in predicting the same. Methodology: The study is a prospective observational study carried out from December 2015 to November 2016, in the Department of Obstetrics and Gynaecology at Dr. T.M.A. Pai Hospital, Udupi. The study population consists of pregnant women booked between 11-14 weeks of gestation with viable pregnancy, who are willing for blood investigation to determine insulin resistance and also those women who gave consent to do uterine artery Doppler. Total 165 patients are included in the study. Out of them 118 patients gave consent to do uterine artery Doppler during NT scan. All patients are followed up for presence of development of gestational diabetes mellitus and hypertensive disorders of pregnancy with mode of delivery, intrapartum and postpartum complications. Results: Likelihood ratio by taking HOMA-IR cut off as 1.87 at 11-14 weeks of gestation was 2.5 stating that with HOMA-IR value as 1.87, pregnant women were 2.5 times more likely to develop gestational diabetes mellitus or hypertensive disorders of pregnancy with advancing gestation. It was observed that HOMA-IR values increased with increase in BMI in present study with p value-0.013, thus was found statistically significant. Out of 72 patients having HOMA-IR ≥ 1.87, 32 patients developed either GDM/HTN which accounted for 45% of women who developed gestational diabetes mellitus or hypertensive disorders in pregnancy. There was an increasing trend in HOMA-IR at 11-14 weeks period of gestation in women who later developed gestational diabetes mellitus or hypertensive disorders in pregnancy. Out of 9 patients having gestational hypertension, 7 patients were having HOMA-IR ≥ 1.87, which accounted for 78% of patients developing gestational hypertension (HTN) in pregnancy. HOMA-IR was a useful marker in predictive gestational hypertension (p value <0.01). Out of 32 patients having gestational diabetes mellitus, 26 patients were having HOMA-IR ≥ 1.87, which accounted for 81% of patients developing gestational diabetes mellitus (GDM) in pregnancy. HOMA-IR was a useful marker in predicting gestational diabetes mellitus (P value <0.01). The combined parameters of study showed 100% sensitivity and 100% negative predictive value for predictability of GDM/HTN in pregnancy. Conclusion: HOMA-IR can be used to predict GDM/Hypertensive disorders of pregnancy at 11-14 weeks gestation with reasonable accuracy. Combined screening algorithm with HOMA-IR, MAP and uterine artery Doppler has limited role and may help only in select high risk population. The prospect of screen positive women being given low dose aspirin (75mg) and advice regarding appropriate dietary management to help prevent the development of hypertensive disorders/GDM in later gestation needs to be explored by larger trials.

Changing Nomenclature from Nonalcoholic Fatty Liver Disease to Metabolic Dysfunction-Associated Fatty Liver Disease – Not Only Premature But Also Confusing

Adverse pregnancy outcomes and risk of type 2 diabetes in postmenopausal women

Cardiovascular risk management following gestational diabetes and hypertensive disorders of pregnancy: a narrative review.

Gestational Diabetes and Hypertensive Disorders of Pregnancy by Maternal Birthplace

Yet more evidence that MAFLD is more than a name change

Women with gestational diabetes mellitus (GDM) and/or hypertensive disorders of pregnancy (HDP) are at increased long-term cardiovascular risk. Mild cardiac functional alterations have been detected in women with GDM or HDP in midgestation, prior to clinical onset of the disease, but these functional alterations have not been found to be useful as screening tools. In contrast, increased impedance to peripheral blood flow, measured by echocardiography or ophthalmic artery Doppler, has been shown to provide incremental value to maternal characteristics for the prediction of pre-eclampsia. However, it is unknown whether similar changes can be detected in women at risk of GDM. In this study, we performed detailed cardiovascular phenotyping in a large, unselected population of women in midgestation to identify similarities and differences in cardiovascular adaptation in women who are at risk of GDM and/or HDP. This was a prospective observational study in women attending for a routine hospital visit at 19 + 1 to 23 + 3 weeks' gestation. This visit included assessment of flow velocity waveforms from the maternal ophthalmic arteries, echocardiography for assessment of maternal cardiovascular function and measurement of uterine artery pulsatility index and serum placental growth factor (PlGF) for assessment of placental perfusion and function. The measured indices were converted to either multiples of the median (MoM) values or deviation from the median (delta) after adjusting for maternal characteristics and elements of medical history. Biomarker delta or MoM values in the GDM and HDP groups were compared with those in the unaffected group using 95% CI and t-tests. The study population of 5214 pregnancies contained 4429 (84.9%) that were unaffected by GDM or HDP, 509 (9.8%) complicated by GDM without HDP, 41 (0.8%) with GDM and HDP, and 235 (4.5%) with HDP without GDM. In HDP cases, with or without GDM, there was evidence of impaired placentation, with a decrease in PlGF, and increased impedance to flow in the peripheral circulation, suggested by an increase in ophthalmic artery peak systolic velocity (PSV) ratio, peripheral vascular resistance assessed on echocardiography and mean arterial pressure. In the GDM group without HDP, there was no evidence of altered placental perfusion or function and ophthalmic artery PSV ratio was not significantly different from that in the unaffected group; peripheral vascular resistance and mean arterial pressure were increased but to a lesser degree than in the HDP group. In the HDP group, there was an increase in global longitudinal systolic strain and slight increase in isovolumic relaxation time, while in the GDM group, there was an increase in mitral valve E/e', myocardial performance index and global longitudinal systolic strain. In midgestation, women who subsequently develop HDP or GDM have a mild subclinical reduction in left ventricular function. In HDP cases, with or without GDM, there is evidence of impaired placentation and all biomarkers of impedance to peripheral blood flow are consistently increased. In contrast, in the GDM group without HDP, biomarkers of placental function are normal and those of impedance to peripheral blood flow are either marginally increased or not significantly different from those in normal pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Gestational diabetes mellitus and hypertensive disorder of pregnancy play as spouse-pair risk factors of diabetes and hypertension: Insights from Tehran Lipid and Glucose Study

Impact of hypertensive disorders of pregnancy and gestational diabetes mellitus on offspring cardiovascular health in early adolescence

Use of oral health services among pregnant women and associations with gestational diabetes and hypertensive disorders of pregnancy: Insights from the 2016-2020 Pregnancy Risk Assessment Monitoring System.

PurposeTo investigate and identify first-trimester fasting plasma glucose (FPG) is related to gestational diabetes mellitus (GDM) and other adverse pregnancy outcomes in Shenzhen population.MethodsWe used data of 48,444 pregnant women that had been retrospectively collected between 2017 and 2019. Logistic regression analysis was used to evaluated the associations between first-trimester FPG and GDM and adverse pregnancy outcomes, and used to construct a nomogram model for predicting the risk of GDM. The performance of the nomogram was evaluated by using ROC and calibration curves. Decision curve analysis (DCA) was used to determine the clinical usefulness of the first-trimester FPG by quantifying the net benefits at different threshold probabilities.ResultsThe mean first-trimester FPG was 4.62 ± 0.42 mmol/L. A total of 6998 (14.4%) pregnancies developed GDM.489(1.01%) pregnancies developed polyhydramnios, the prevalence rates of gestational hypertensive disorder (GHD), cesarean section, primary cesarean section, preterm delivery before 37 weeks (PD) and dystocia was 1130 (2.33%), 20,426 (42.16%), 7237 (14.94%), 2386 (4.93%), and 1865 (3.85%), respectively. 4233 (8.74%) of the newborns were LGA, and the number of macrosomia was 2272 (4.69%), LBW was 1701 (3.51%) and 5084 (10.49%) newborns had admission to the ICU, which all showed significances between GDM and non-GDM groups (all P < 0.05). The univariate analysis showed that first-trimester FPG was strongly associated with risks of outcomes including GDM, cesarean section, macrosomia, GHD, primary cesarean section, and LGA (all OR > 1, all P < 0.05), furthermore, the risks of GDM, primary cesarean section, and LGA was increasing with first-trimester FPG as early as it was at 4.19–4.63 mmol/L. The multivariable analysis showed that the risks of GDM (ORs for FPG 4.19–4.63, 4.63–5.11 and 5.11–7.0 mmol/L were 1.137, 1.592, and 4.031, respectively, all P < 0.05) increased as early as first-trimester FPG was at 4.19–4.63 mmol/L, and first-trimester FPG which was also associated with the risks of cesarean section, macrosomia and LGA (OR for FPG 5.11–7.0 mmol/L of cesarean section: 1.128; OR for FPG 5.11–7.0 mmol/L of macrosomia: 1.561; OR for FPG 4.63–5.11 and 5.11–7.0 mmol/L of LGA: 1.149 and 1.426, respectively, all P < 0.05) and with its increasing, the risks of LGA increased. Furthermore, the nomogram had a C-indices 0.771(95% CI: 0.763~0.779) and 0.770(95% CI:0.758~0.781) in training and testing validation respectively, which showed an acceptable consistency between the observed, validation and nomogram-predicted probabilities, the DAC curve analysis indicated that the nomogram had important clinical application value for GDM risk prediction.ConclusionsFPG in the first trimester was an independent risk factor for GDM which can be used as a screening test for identifying pregnancies at risk of GDM and adverse pregnancy outcomes.

Accruing evidence suggests that gestational hypertensive disorders (GHTD) and gestational diabetes (GD) are each associated with an increased risk of cardiovascular disease (CVD). However, the extent to which the co-occurrence of GHTD and GD is associated with the risk of CVD remains largely unknown. To estimate the individual and joint associations of GHTD and GD with incident CVD. This population-based cohort study used the Ministry of Health and Long-Term Care of Ontario (Canada) health care administrative databases. All women in Ontario with a GHTD and/or GD diagnosis, and a live-birth singleton delivery between July 1, 2007, and March 31, 2018, were considered for inclusion. Women with pregravid diabetes, hypertension, or cardiovascular disease were excluded. Statistical analysis was performed from November 2021 to September 2022. GD and/or GHTD, defined using diagnosis coding. Individual and joint associations of GHTD and GD with incident CVD (including a composite of myocardial infarction, acute coronary syndrome, stroke, coronary artery bypass grafting, percutaneous coronary intervention, or carotid endarterectomy), estimated using Cox regression models, adjusting for relevant cardiometabolic risk factors. The follow-up extended from the index pregnancy until March 31, 2020. Among 886 295 eligible women (mean [SD] age, 30 [5.6] years; 43 861 [4.9%] with isolated GHTD, 54 061 [6.1%] with isolated GD, and 4975 [0.6%] with GHTD and GD), there were 1999 CVD events over 12 years of follow-up. In the early postpartum phase (first 5 years post partum), there was no association of co-occurrence of GTHD and GD (adjusted hazard ratio [aHR], 1.42, 95% CI, 0.78-2.58) or GD alone (aHR, 0.80; 95% CI, 0.60-1.06) with CVD; there was an association between isolated GTHD and incident CVD compared with no GTHD and no GD (aHR, 1.90; 95% CI, 1.51-2.35). In the late postpartum period (after the initial 5 years post partum), compared with no GD and no GHTD, isolated GHTD (aHR, 1.41, 95% CI, 1.12-1.76) and co-occurrence of GHTD and GD (aHR, 2.43, 95% CI, 1.60-3.67) were each associated with a higher risk of incident CVD. There was no association between isolated GD and incident CVD. In this cohort study, GHTD was associated with a high risk of CVD post partum, and the co-occurrence of GD and GHTD was associated with a much greater postpartum CVD risk. These findings suggest that CVD preventive care is particularly needed in the aftermath of combined GD and GHTD.