Nonalcoholic steatohepatitis and obesity: influence of key risk factors on the development of obstetric and perinatal complications in pregnant women
DOI:
https://doi.org/10.14739/2310-1210.2022.3.252654Keywords:
non-alcoholic steatohepatitis, obesity, body mass index, lipid metabolism, pregnancy complicationsAbstract
The aim of our study is to assess the development of obstetric and perinatal complications in obese pregnant women with non-alcoholic steatohepatitis (NASH) depending on changes in blood lipid spectrum and body mass index (BMI).
Materials and methods. We examined 98 pregnant women with non-alcoholic fatty liver disease (NAFLD) at the stage of NASH in combination with obesity. The control group consisted of 30 healthy pregnant women. All pregnant women with NAFLD and abdominal obesity were divided into 3 groups depending on BMI: Group I – 26 pregnant women with BMI 25.0–29.9 kg/m², Group II – 48 pregnant women with BMI 30.0–34.9 kg/m2, Group III – 24 pregnant women with BMI 35.0–39.9 kg/m2. Correlations of obstetric complications depending on changes in lipid metabolism and BMI were determined.
Results. The analysis of obstetric complications revealed 3.4 times higher risk of early miscarriage in group I, 5.6 times – in group II, 7.5 times – in group III compared the control group (P < 0.05); early gestosis occurred 1.9 times more often in group I, 2.5 times – in group II, 3.3 times – in group III as compared to that in pregnant women of the control group (P < 0.05); the threat of premature birth was found 3.4 times more frequently in group I, 5.6 times – in group II, 7.5 times – in group III as compared with the control group (P < 0.05).
Group I patients developed placental dysfunction with a frequency of 2.3 times, group II – of 4.0 times, and group III – of 6.3 times greater than pregnant women of the control group (P < 0.05), and moderate preeclampsia was diagnosed in overweight pregnant women, as well as in women with grade I and grade II–III obesity 2.3 times, 4.7 times and 5.6 times as often, respectively, as in the control group (P < 0.05). Correlation analysis showed correlations between lipid metabolism indicators and an increase in BMI.
Conclusions. Obese pregnant women with NAFLD at the stage of NASH were found to have significantly more frequent obstetric and perinatal complications as well as lipid profile abnormalities correlating with increased BMI, which may be due to the presence of NASH and functional liver failure.
References
Friedman, S. L., Neuschwander-Tetri, B. A., Rinella, M., & Sanyal, A. J. (2018). Mechanisms of NAFLD development and therapeutic strategies. Nature Medicine, 24(7), 908-922. https://doi.org/10.1038/s41591-018-0104-9
Hershman, M., Mei, R., & Kushner, T. (2019). Implications of Nonalcoholic Fatty Liver Disease on Pregnancy and Maternal and Child Outcomes. Gastroenterology & Hepatology, 15(4), 221-228.
Mousa, N., Abdel-Razik, A., Shams, M., Sheta, T., Zakaria, S., Shabana, W., Effat, N., El-Diasty, M., Abed, S., Abd Elsalam, M., Awad, M., Salah, M., El-Wakeel, N., Deiab, A. G., & Eldars, W. (2018). Impact of non-alcoholic fatty liver disease on pregnancy. British Journal of Biomedical Science, 75(4), 197-199. https://doi.org/10.1080/09674845.2018.1492205
Lee, S. M., Kwak, S. H., Koo, J. N., Oh, I. H., Kwon, J. E., Kim, B. J., Kim, S. M., Kim, S. Y., Kim, G. M., Joo, S. K., Koo, B. K., Shin, S., Vixay, C., Norwitz, E. R., Park, C. W., Jun, J. K., Kim, W., & Park, J. S. (2019). Non-alcoholic fatty liver disease in the first trimester and subsequent development of gestational diabetes mellitus. Diabetologia, 62(2), 238-248. https://doi.org/10.1007/s00125-018-4779-8
Lee, Y. W., & Yarrington, C. D. (2017). Obstetric Outcomes in Women with Nonalcoholic Fatty Liver Disease. Metabolic Syndrome and Related Disorders, 15(8), 387-392. https://doi.org/10.1089/met.2017.0058
Wu, K. T., Kuo, P. L., Su, S. B., Chen, Y. Y., Yeh, M. L., Huang, C. I., Yang, J. F., Lin, C. I., Hsieh, M. H., Hsieh, M. Y., Huang, C. F., Lin, W. Y., Yu, M. L., Dai, C. Y., & Wang, H. Y. (2016). Nonalcoholic fatty liver disease severity is associated with the ratios of total cholesterol and triglycerides to high-density lipoprotein cholesterol. Journal of Clinical Lipidology, 10(2), 420-425.E1. https://doi.org/10.1016/j.jacl.2015.12.026
Hagström, H., Höijer, J., Ludvigsson, J. F., Bottai, M., Ekbom, A., Hultcrantz, R., Stephansson, O., & Stokkeland, K. (2016). Adverse outcomes of pregnancy in women with non-alcoholic fatty liver disease. Liver International, 36(2), 268-274. https://doi.org/10.1111/liv.12902
Herath, R. P., Siriwardana, S. R., Ekanayake, C. D., Abeysekara, V., Kodithuwakku, S., & Herath, H. P. (2019). Non-alcoholic fatty liver disease and pregnancy complications among Sri Lankan women: A cross sectional analytical study. PLOS ONE, 14(4), Article e0215326. https://doi.org/10.1371/journal.pone.0215326
Ram, M., Berger, H., Lipworth, H., Geary, M., McDonald, S. D., Murray-Davis, B., Riddell, C., Hasan, H., Barrett, J., Melamed, N., & DOH-Net (Diabetes, Obesity and Hypertension in Pregnancy Research Network) and SOON (Southern Ontario Obstetrical Network) Investigators. (2020). The relationship between maternal body mass index and pregnancy outcomes in twin compared with singleton pregnancies. International Journal of Obesity, 44(1), 33-44. https://doi.org/10.1038/s41366-019-0362-8
Avcı, M. E., Şanlıkan, F., Çelik, M., Avcı, A., Kocaer, M., & Göçmen, A. (2015). Effects of maternal obesity on antenatal, perinatal and neonatal outcomes. The Journal of Maternal-Fetal & Neonatal Medicine, 28(17), 2080-2083. https://doi.org/10.3109/14767058.2014.978279
Zhang, Y., Wang, Z. L., Liu, B., & Cai, J. (2014). Pregnancy outcome of overweight and obese Chinese women with gestational diabetes. Journal of Obstetrics and Gynaecology, 34(8), 662-665. https://doi.org/10.3109/01443615.2014.920787
Subichin, M., Clanton, J., Makuszewski, M., Bohon, A., Zografakis, J. G., & Dan, A. (2015). Liver disease in the morbidly obese: a review of 1000 consecutive patients undergoing weight loss surgery. Surgery for Obesity and Related Diseases, 11(1), 137-141. https://doi.org/10.1016/j.soard.2014.06.015
Masuoka, H. C., & Chalasani, N. (2013). Nonalcoholic fatty liver disease: an emerging threat to obese and diabetic individuals. Annals of the New York Academy of Sciences, 1281(1), 106-122. https://doi.org/10.1111/nyas.12016
Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., Harrison, S. A., Brunt, E. M., & Sanyal, A. J. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67(1), 328-357. https://doi.org/10.1002/hep.29367
Koehler, E. M., Plompen, E. P., Schouten, J. N., Hansen, B. E., Darwish Murad, S., Taimr, P., Leebeek, F. W., Hofman, A., Stricker, B. H., Castera, L., & Janssen, H. L. (2016). Presence of diabetes mellitus and steatosis is associated with liver stiffness in a general population: The Rotterdam study. Hepatology, 63(1), 138-147. https://doi.org/10.1002/hep.279
Melchor, I., Burgos, J., Del Campo, A., Aiartzaguena, A., Gutiérrez, J., & Melchor, J. C. (2019). Effect of maternal obesity on pregnancy outcomes in women delivering singleton babies: a historical cohort study. Journal of Perinatal Medicine, 47(6), 625-630. https://doi.org/10.1515/jpm-2019-0103
Echeverria, C., Eltit, F., Santibanez, J. F., Gatica, S., Cabello-Verrugio, C., & Simon, F. (2020). Endothelial dysfunction in pregnancy metabolic disorders. Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease, 1866(2), Article 165414. https://doi.org/10.1016/j.bbadis.2019.02.009
Sarkar, M., Grab, J., Dodge, J. L., Gunderson, E. P., Rubin, J., Irani, R. A., Cedars, M., & Terrault, N. (2020). Non-alcoholic fatty liver disease in pregnancy is associated with adverse maternal and perinatal outcomes. Journal of Hepatology, 73(3), 516-522. https://doi.org/10.1016/j.jhep.2020.03.049
Younossi, Z. M. (2018). Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Implications for liver transplantation. Liver Transplantation, 24(2), 166-170. https://doi.org/10.1002/lt.25003
Ministry of Health of Ukraine. (2014, November 6). Pro zatverdzhennia ta vprovadzhennia medyko-tekhnolohichnykh dokumentiv zi standartyzatsii medychnoi dopomohy pry khronichnykh neinfektsiinykh hepatytakh [On approval and implementation of medical and technological documents standardizing medical care of chronic non-infectious hepatitis (No. 826)]. https://ips.ligazakon.net/document/MOZ24038?ed=2014_11_06&an=19
Westbrook, R. H., Dusheiko, G., & Williamson, C. (2016). Pregnancy and liver disease. Journal of Hepatology, 64(4), 933-945. https://doi.org/10.1016/j.jhep.2015.11.030
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
