This study evaluates the prevalence and factors associated with NAFLD in Indian women with prior GDM diagnosed using IADPSG criteria.
This cross-sectional study (2018-2019) enrolled women with and without prior GDM. Study participants underwent detailed assessments including enquiry of relevant medical, obstetric, and demographic details, 75 g OGTT with glucose and insulin estimation at 0, 30, and 120 min, and other relevant biochemical and anthropometric measurements. NAFLD status was defined by ultrasonography.
We evaluated a total of 309 women (201 and 108 with and without prior GDM respectively) at a mean (± SD) age of 31.9 (± 5.0) years and median (IQR) of 16 (9-38) months following the index delivery. Prevalence of NAFLD was significantly higher in women with prior GDM [62.7% vs 50.0%, p = 0.038] [Grade 2 and 3 disease, 13.9% vs 6.5%]. On logistic regression analysis (fully adjusted model), the odds of NAFLD were 2.11-fold higher in women with prior GDM (95% CI 1.16, 3.85, p=0.014). Overweight/obesity, metabolic syndrome, prediabetes, and HOMA-IR (a measure of insulin resistance) were positively associated with NAFLD, while Matsuda index (a measure of insulin sensitivity) showed a negative association with NAFLD.
The prevalence of NAFLD is high in women with prior GDM. Such women also have a high burden of cardiometabolic risk factors. Future studies should evaluate the intermediate and long-term hepatic and cardiovascular risk and the impact of lifestyle interventions in reducing morbidity in such women.

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