International Journal of Women's Health (Apr 2023)
Elevated Hepatic Steatosis Index is Associated with the Development of Adverse Maternal, but Not Adverse Neonatal, Outcomes: A Retrospective Cohort Study
Abstract
Thora Y Chai,1– 3 Karen Byth,2,4 Jacob George,2,5,6 Dharmintra Pasupathy,3 N Wah Cheung1– 3 1Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Australia; 2Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; 3Reproduction and Perinatal Centre, The University of Sydney, Sydney, NSW, Australia; 4Western Sydney Local Health District Research Education Network, Westmead, NSW, Australia; 5Storr Liver Centre, Westmead Millennium Institute for Medical Research, Westmead, NSW, Australia; 6Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, NSW, AustraliaCorrespondence: Thora Y Chai, Email [email protected]: To determine whether an elevated hepatic steatosis index (HSI), a non-invasive test for possible metabolic dysfunction-associated fatty liver disease (MAFLD), is associated with the development of adverse pregnancy outcomes.Material and Methods: A retrospective cohort study was conducted on adult women with singleton pregnancies who delivered at two tertiary hospitals from August 2014 to December 2017. Aspartate aminotransaminase (AST) and alanine aminotransaminase (ALT) levels obtained 12 months pre-gravid, or during pregnancy but prior to screening for gestational diabetes mellitus (GDM), were extracted and linked with oral glucose tolerance test results. The HSI was calculated using the following equation: 8 × (ALT/AST ratio) + BMI (+2 if female; +2 if diabetes mellitus present) and considered elevated if > 36. Multiple logistic regression analysis was used to quantify the association between elevated HSI and each composite adverse pregnancy outcome after adjusting for independent maternal risk factors.Results: Over 40-months, 11929 women were eligible and of these, 1885 had liver enzymes collected. Women with an elevated HSI (> 36) were more likely multiparous and overweight/obese compared to those women with a non–elevated HSI (≤ 36). Elevated HSI was significantly associated with a composite of adverse maternal outcomes (adjusted odds ratio (aOR) 1.55 95% CI 1.11– 2.17, p=0.01), although a non-significant increased risk of a composite of adverse neonatal outcomes occurred after multivariable adjustment (aOR 1.17, 95% CI 0.94– 1.45, p=0.17).Conclusion: Over and above known maternal risk factors, women with elevated HSI were more likely to develop adverse maternal, but not adverse neonatal outcomes.Keywords: liver steatosis, pregnancy outcomes, liver function tests, maternal health, neonatal health
