. 2019 Apr;15(4):221–228.

Table.

Studies Evaluating the Relationship Between GDM and NAFLD

Predictor and Outcome Factor	Number of Subjects, n	Timing of Association	NAFLD Criteria	Diagnostic Criteria of GDM (Glucose mmol/L)	Association OR/RR (95% CI)	Multivariable Adjusted Association aOR/aRR (95% CI)	Other Significant NAFLD Factors aOR/aRR (95% CI)
Forbes et al¹¹
Predictor: Prior GDM Outcome factor: NAFLD	Prior GDM, 110 Control, 113	1-10 years postpartum	US-graded steatosis	75 g OGTT: FPG ≥7; 2 hr ≥7.8	N/A	aOR, 2.77^a (1.43-5.37)	HOMA insulin sensitivity/1 SD: aOR, 0.08 (0.04-0.19) ALT/1 SD (13 U/L): aOR, 2.85 (1.63-4.98)
Ajmera et al¹⁰
Predictor: Prior GDM Outcome factor: NAFLD	Prior GDM, 124 Control, 991	Study enrollment to year 25	CT LA ≤40 HU	Self-report	OR, 2.56 (1.44-4.55)	aOR, 2.29 (1.23-4.27)	Baseline HOMA-IR: aOR, 1.56 (1.2-2.04) Baseline triglycerides: aOR, 1.05 (1.01-1.11)
De Souza et al¹⁵
Predictor: NAFLD at 11-14 weeks Outcome factor: IFG/IGT/GDM at 24-48 weeks	Total, 476	Peripartum	US-graded steatosis	75 g OGTT: FPG ≥5.3; 1 hr ≥10.6; 2 hr ≥8.9	OR, 2.5 (1.3-4.8)	aOR, 2.2 (1.1-4.3)	N/A
Hagström et al²²
Predictor: NAFLD Outcome factor: GDM	NAFLD, 110 Control, 952,397	Peripartum	ICD-9, ICD-10	ICD-9, ICD-10	RR, 6.77 (3.31-13.87)	aRR, 2.78 (1.25-6.15)	Preeclampsia: aRR, 1.95 (1.03-3.70) Caesarean section: aRR, 1.52 (1.19-1.94) Low birth weight: aRR, 2.40 (1.21-4.78) Delivery <32 weeks: aRR, 6.92 (2.96-16.14)
Foghsgaard et al¹²
Predictor: Prior GDM Outcome factor: NAFLD	Prior GDM, 100 Control, 11	Median 4.5-4.8 years postpartum	US	75 g OGTT: 2 hr ≥9	N/A	N/A	IR: aOR, 0.44 (0.23-0.75) Waist circumference: aOR, 1.07 (1.02-1.12)
Mehmood et al²¹
Predictor: GDM Outcome factor: NAFLD	GDM, 97 Gestational IGT, 40^b Control, 120	Mean 4.8 years postpartum	US-graded steatosis	100 g OGTT: FPG ≥5.8; 1 hr ≥10.6; 2 hr ≥9.2; 3 hr ≥8.1	OR, 3.66 (1.1-12.5)	N/A	N/A
Mousa et al²³
Predictor: NAFLD Outcome factor: GDM	NAFLD, 200 Control, 200	Peripartum	US	75 g OGTT: FPG ≥7; 2 hr ≥11.1	33% with NAFLD vs 10% without	N/A	N/A
Lee et al¹⁶
Predictor: NAFLD at 10-14 weeks Outcome factor: GDM at 24-48 weeks	NAFLD, 112 GDM, 36 Total, 608	Peripartum	US-graded steatosis, fatty liver index, hepatic steatosis index	50 g GCT: 1 hr ≥7.8 100 g OGTT ≥2: FPG ≥5.3; 1 hr ≥10; 2 hr ≥8.6; 3 hr ≥7.8	OR, 6.45 (3.26-12.97)	N/A	N/A

Univariate adjustment for body mass index.

Gestational IGT defined by only 1 OGTT value above threshold.

ALT, alanine aminotransaminase; aOR, adjusted odds ratio; aRR, adjusted relative risk; CT LA, computed tomography quantification of liver attenuation; FPG, fasting plasma glucose; GCT, glucose challenge test; GDM, gestational diabetes mellitus; HOMA, Homeostatic Model Assessment; hr, hour; HU, Hounsfield units; ICD, International Classification of Disease; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; IR, insulin resistance; N/A, not available; NAFLD, nonalcoholic fatty liver disease; OGTT, oral glucose tolerance test; OR, odds ratio; RR, relative risk; SD, standard deviation; US, ultrasound.