Fatty liver indices and their association with glucose metabolism in pregnancy – An observational cohort study

Aims: Non-invasive hepatic steatosis indices can be used to assess the risk for metabolic (dysfunction) associated fatty liver disease (MAFLD). This may be helpful to detect metabolic disorders in pregnancy, specifically gestational diabetes (GDM). We aim to examine the association of these indices with parameters of glucose metabolism. Methods: 109 women underwent a metabolic characterization at 16 weeks of gestation and were classified according to the fatty-liver index (FLI) and hepatic-steatosis index (HSI) into low (G1), intermediate (G2) and high risk (G3). At 26 weeks, participants received an oral glucose tolerance test (OGTT) to assess insulin action, β-cell function and GDM status. Results: Both MAFLD indices were associated with impaired insulin sensitivity and compensatory increase of insulin release. G3 groups showed impaired insulin action. The higher circulating insulin concentrations were not able to compensate for insulin resistance in women with higher MAFLD scores, resulting in an increased risk of GDM (OR: 1.05, 95% CI 1.03 to 1.08, p < 0.001 for FLI). MAFLD scores were associated with fetal overgrowth. Conclusions: Maternal MAFLD represents a high-risk obstetric condition. Hepatic steatosis indices are associated with impaired glucose regulation and may provide a useful tool for early risk assessment for impaired glucose metabolism.