Pregnancy Dysglycemia and Estimated Risk of Metabolic Dysfunction–Associated Steatotic Liver Disease 10–14 Years After Delivery

OBJECTIVE: To determine whether pregnancy dysglycemia in the early third trimester was associated with a higher estimated risk of postpartum metabolic dysfunction–associated steatotic liver disease (MASLD) assessed 10–14 years after delivery. METHODS: This was a secondary analysis from the prospective international cohort study HAPO FUS (Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study). The exposure was pregnancy dysglycemia in the third trimester, identified by the glucose summary z-score of a 75-g oral glucose tolerance test (OGTT) at 24–32 weeks of gestation, and, secondarily, a diagnosis of gestational diabetes mellitus (GDM). The outcome was the estimated 6-year risk of MASLD determined by the Framingham Fatty Liver Disease Risk Function. Multivariable linear and multinomial regression models were used and adjusted for baseline covariates at the time of the OGTT, including study field center, age, parity, gestational age, and duration from enrollment to follow-up. RESULTS: Of 4,697 assessed pregnant individuals, the median age was 30.5 years (interquartile range 26.0, 34.1 years) and the median body mass index was 26.6 (interquartile range 24.1, 29.9); 14.3% (n=672) were diagnosed with GDM. At 10–14 years after delivery (median 11.6 years, interquartile range 10.8, 12.4 years), the median estimated 6-year risk of MASLD was 6.0% (interquartile 3.0%, 13.0%). Individuals with a higher third trimester glucose summary z-score were at higher estimated risk of postpartum MASLD (adjusted beta coefficient 3.2 per 1 SD; 95% CI, 2.7–3.6), as were those who were diagnosed with GDM (adjusted beta coefficient 4.2%; 95% CI, 3.1–5.2). When MASLD risk was assessed in tertiles, an increase of 1 SD in the summary z-score was associated with greater adjusted odds of being in the highest-risk MASLD tertile (adjusted odds ratio 1.1; 95% CI, 1.0–1.3); however, a diagnosis of GDM was not associated with greater adjusted odds of being in the highest-risk MASLD tertile. CONCLUSION: Increasing pregnancy dysglycemia in the third trimester was associated with a higher estimated risk of postpartum MASLD using cardiometabolic risk factors measured 10–14 years after delivery. Whether postpartum interventions to improve cardiometabolic health for individuals with prior pregnancy dysglycemia decreases the risk of MASLD requires further investigation.