Gestational diabetes predicts future risk of serious liver disease in young women

Aims/Hypothesis — In common with type 2 diabetes, gestational diabetes mellitus (GDM) is associated with a propensity for hepatic fat deposition. We hypothesised that GDM predicts future lifetime risk of serious liver-disease outcomes, such as cirrhosis, liver failure and need for transplantation.

Methods — From population-based administrative databases, we identified all women in Ontario, Canada, who had a pregnancy resulting in live birth between April 1994 and March 2002 (N = 698,078). This population was stratified into individuals with (n = 17,932) and without (n = 680,146) GDM, and both groups were further stratified according to subsequent development of type 2 diabetes in the years after delivery. The median follow-up for the development of serious liver disease (defined as hospitalisation for cirrhosis, liver failure or transplantation) was 14.0 years.

Results — Women with GDM had a higher risk of serious liver disease than those without GDM (n = 680,146; HR = 1.40, 95% CI 1.01, 1.94). Compared with women who did not have GDM and did not develop diabetes (n = 635,998), those with GDM who subsequently developed type 2 diabetes (n = 8567) had a higher risk of serious liver disease (adjusted HR = 1.56, 95% CI 1.02, 2.39), as did those without GDM who developed type 2 diabetes (n = 44,148; adjusted HR = 2.48, 95% CI 2.10, 2.93), but not those with GDM who did not develop type 2 diabetes (n = 9365; adjusted HR = 1.15, 95% CI 0.69, 1.91).

Conclusion/Interpretation — GDM is associated with future risk of serious liver disease in young women, the development of which may be dependent upon progression to non-gestational diabetes.