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Association between gestational diabetes mellitus and liver cirrhosis and fibrosis: A population-based cohort study
Tan-Tzu Lo1, Wan-Ting Huang2, Chia-Lung Shih2
1Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan.
Background:
Gestational diabetes mellitus (GDM) is a metabolic disorder characterized by glucose intolerance first recognized during pregnancy. Thus, women with a history of GDM might be at increased risk of developing serious liver disease. However, this association is unclear in the Taiwanese population.
Objective:
This study investigated the association between GDM and liver cirrhosis or fibrosis.
Methods:
This is a retrospective cohort study. The participants were collected from the National Health Insurance Research Database. The study included women aged 18-52 years who gave birth in Taiwan between 2002 and 2017. Of the 145 974 total participants, 133 794 were women without GDM and 12 153 had GDM. We applied the Cox proportional hazards model to calculate hazard ratios (HRs) for potential risk factors associated with liver cirrhosis or fibrosis.
Results:
Our results demonstrate that women with a GDM history were not at increased risk of developing liver cirrhosis or fibrosis compared to those without GDM (hazard ratios [HR]: 0.58, 95% confidence interval [CI]: 0.31-1.09), even after adjustment for potential confounders (adjusted HR: 0.56, 95% CI: 0.30-1.06). Among women without a history of GDM, those who subsequently developed DM had an increased risk of liver cirrhosis or fibrosis compared with those without developed DM (HR: 2.45, 95% CI: 1.54-3.90), even after adjustment for potential confounders (adjusted HR: 1.93, 95% CI: 1.19-3.13). However, this association was not observed among women with a history of GDM who developed DM, compared with those who remained free of DM. We showed that age (adjusted HR: 2.61; 95% CI: 1.94-3.51), hypertension (adjusted HR: 2.27; 95% CI: 1.03-4.98), and dyslipidemia (adjusted HR: 2.84; 95% CI: 1.30-6.22) increased the risk of developing liver cirrhosis or fibrosis. Notably, hypertension remained a significant risk factor among women without a history of GDM.
Conclusion:
A history of GDM was not associated with an increased risk of developing liver cirrhosis or fibrosis. However, women without a history of GDM who later developed DM exhibited a significantly higher risk of liver cirrhosis or fibrosis.
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