Main Findings
NAFLD during pregnancy partially reflects the physiological changes with fluctuation of oestrogen, lipid levels and rapid weight gain during pregnancy 31. Nevertheless, the link between NAFLD and GDM has been studied on both directions. NAFLD in the first trimester has shown to be a risk factor for dysglycemia in mid pregnancy32, and having gestational diabetes was also identified as a risk factor for postpartum development of NAFLD33. This study indicates that prevalence of fatty liver among pregnant women in Anuradhapura, Sri Lanka is much higher than the reported values from HICs and the previously reported in the South Asian context. Strengthening the evidence generated elsewhere34,35 this prospective study indicate that NAFLD, specifically Fatty liver Grade II? Correct? is a major risk factor for subsequent development of GDM in pregnancy. Although this association is reported in HICs, this is the first study to reflect this in the rural Asian population using a community based on a prospective cohort study. The study also depict that NAFLD is associated with early pregnancy miscarriage. Several past studies report that NAFLD may not be a significant risk factor for diabetes after adjusting for BMI and age32. In our study, the fatty liver grade II was the only risk factor for developing GDM/DIP, even after adjusting for these confounding variables. The diagnostic thresholds and criteria for GDM are different across the globe and are evolving. The strength of the association in this study is difficult to compare directly with many previous studies due to the differences in GDM diagnostic criteria. De Souza et al. used similar criteria for GDM and revealed an adjusted OR ranging from 6.8-7.8 34. Mousa et al. also reported significantly higher incidence of GDM among pregnant mothers with fatty liver 32. Our estimates are much larger yet have wide confidence intervals (similar to the study by De Souza et al.)