First-trimester fatty liver index and hepatic steatosis index independently predict gestational diabetes risk: a...

Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication characterized by complex metabolic pathophysiology. Although both the fatty liver index (FLI) and hepatic steatosis index (HSI) are well-established non-invasive markers for hepatic steatosis, their predictive value for GDM risk in the Korean population remains underexplored.

This prospective cohort study enrolled 573 singleton pregnancies. FLI and HSI were calculated at 10-14 weeks of gestation. GDM was diagnosed via a two-step oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. Multivariable logistic regression models were applied to assess the associations between FLI/HSI and GDM risk. Sensitivity and subgroup analyses were performed to verify the robustness of the findings, while receiver operating characteristic (ROC) curve analyses were conducted to evaluate the predictive performance of the two indices.

The mean age of the participants was 32.1 years, with a mean FLI of 18.0 and a mean HSI of 30.0. The overall incidence of GDM was 6.3%. After adjusting for confounding factors (age, high-density lipoprotein cholesterol (HDL-C), homeostasis model assessment of insulin resistance (HOMA-IR), free fatty acid (FFA), and gestational hypertension or preeclampsia), each 1-unit increase in FLI was associated with a 5% higher risk of GDM [odds ratio (OR) = 1.05, 95% confidence interval (CI): 1.03-1.06]. Similarly, each 1-unit increase in HSI correlated with a 19% elevated GDM risk (OR = 1.19, 95% CI: 1.11-1.28). Sensitivity and subgroup analyses further confirmed the stability of these associations. FLI exhibited superior predictive ability for GDM compared with HSI, with an area under the curve (AUC) of 0.8133 (95% CI: 0.7275-0.8991) versus 0.7868 (0.7075-0.8661) for HSI.

Both FLI and HSI independently predict GDM risk in Korean women, with FLI demonstrating marginally better performance. Their early-pregnancy assessment (10-14 weeks) may enhance risk stratification and enable targeted preventive strategies.