Association between history of abortion and nonalcoholic fatty liver disease in middle-aged and elderly Chinese women

Research progress on the mitochondrial mechanism of age-related non-alcoholic fatty liver

Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease worldwide. Reduced activity and slower metabolism in the elderly affect the balance of lipid metabolism in the liver leading to the accumulation of lipids. This affects the mitochondrial respiratory chain and the efficiency of β-oxidation and induces the overproduction of reactive oxygen species. In addition, the dynamic balance of the mitochondria is disrupted during the ageing process, which inhibits its phagocytic function and further aggravates liver injury, leading to a higher incidence of NAFLD in the elderly population. The present study reviewed the manifestations, role and mechanism of mitochondrial dysfunction in the progression of NAFLD in the elderly. Based on the understanding of mitochondrial dysfunction and abnormal lipid metabolism, this study discusses the treatment strategies and the potential therapeutic targets for NAFLD, including lipid accumulation, antioxidation, mitophagy and liver-protecting drugs. The purpose is to provide new ideas for the development of innovative drugs for the prevention and treatment of NAFLD.

Premenopausal Syndrome and NAFLD: A New Approach Based on Gender Medicine

Non-alcoholic fatty liver disease (NAFLD) is a multifactorial condition that affects 25% of the world's population. There is a clear difference in both geographical distribution and sex in childbearing age. These differences are reduced when women become older and senescence begins. The factors that affect the likelihood of developing NAFLD in a premenopausal woman are an imbalance of sex hormones (especially in estradiol and androgen), microbiome dysregulation, insulin resistance, early menarche, the length of time that the woman breastfeeds for and polycystic ovarian syndrome (PCOS). The aim of this review is to identify various physical ailments that may not appear to be serious to young women but that then affect the onset of NAFLD in perimenopause and can degenerate into NASH. These conditions should also be considered in future clinical management, as well as in research opportunities, in order to customize the monitoring and treatment of NAFLD, considering gender medicine for those women who had early metabolic symptoms that were not considered to be significant at the time.

Association of History of Spontaneous or Induced Abortion With Subsequent Risk of Gestational Diabetes

IMPORTANCE

Gestational diabetes (GD) is one of the most common and important complications of pregnancy. Identifying pregnant women who are at high risk of GD is crucial for implementing early prevention and intervention.

OBJECTIVE

To examine whether a history of spontaneous abortion (SAB) or induced abortion is associated with increased risk of GD in subsequent pregnancies.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study was conducted at a tertiary hospital in Shanghai, China. Pregnant women who received routine antenatal care between January 2014 and December 2019 were included. Data analysis was performed from December 2020 to June 2021.

EXPOSURES

Maternal history of abortion, including SAB and induced abortion, were extracted from medical records.

MAIN OUTCOMES AND MEASURES

GD was diagnosed with a 75-g diagnostic oral glucose tolerance test. A multivariable-adjusted log-binomial analysis was used to estimate relative risks (RRs) and 95% CIs of GD associated with history of abortion.

RESULTS

Among the 102 259 included pregnant women (mean [SD] age, 29.8 [3.8] years), 14 579 (14.3%) experienced only SAB, 17 935 (17.5%) experienced only induced abortion, and 4017 (3.9%) experienced both SAB and induced abortion. A total of 12 153 GD cases were identified, and the prevalence of GD was 11.9% (12 153 of 102 259 women) in this cohort. Pregnant women who experienced only SAB (RR, 1.25; 95% CI, 1.18-1.31) or both SAB and induced abortion (RR, 1.15; 95% CI, 1.05-1.27) were at higher risk of developing GD. The association of SAB history with GD occurred in a number-dependent manner. Compared with pregnant women with no history of abortion, the RR for GD increased by 18% (RR, 1.18; 95% CI, 1.11-1.26) for pregnant women with 1 SAB, by 41% (RR, 1.41; 95% CI, 1.27-1.57) for those with 2 SABs, and by 43% (RR, 1.43; 95% CI, 1.22-1.67) for those more than 2 SABs. However, no association between history of induced abortion and GD was observed.

CONCLUSIONS AND RELEVANCE

This study found that a history of SAB was associated with increased risk of GD in subsequent pregnancies. Further research is needed to clarify this association and explore the potential biological mechanisms underlying the association.

Non-alcoholic fatty liver disease (NAFLD): a significant predictor of gestational diabetes mellitus (GDM) and early pregnancy miscarriages-prospective study in Rajarata Pregnancy Cohort (RaPCo)

BACKGROUND AND AIMS

Non-alcoholic fatty liver disease (NAFLD) is increasing globally with a mounting body of evidence on various adverse effects on pregnancy. Yet, prospective studies, especially from low-income and middle-income countries, are lacking in examining the impact of NAFLD in pregnancy. In this study, we explored the effect of NAFLD on the development of gestational diabetes mellitus (GDM) and early pregnancy miscarriages.

METHODS

A population-based prospective cohort study was conducted among first-trimester pregnant women who registered in the national pregnancy care programme during July-September 2019 in Anuradhapura district, Sri Lanka. Baseline clinical-biochemical parameters and ultrasound scan (USS) of the liver were done to assess fatty liver. Those who were normoglycaemic based on WHO criteria were followed up, and a repeat oral glucose tolerance test was performed between 24 and 28 weeks of gestation.

RESULTS

Of the 632 pregnant women studied, 90 (14%) and 234 (37%) were diagnosed as having fatty liver grade (FLG) II and I, respectively. The cumulative incidence of GDM in FLG 0, I, and II were 11, 44, and 162 per 1000 pregnancies, respectively. After adjusting for age and other known risk factors, women with FLG II had a relative risk (RR) of 12.5 (95% CI 2.2 to 66.4) for developing GDM compared with FLG 0. In addition, women with FLG I (RR 2.1, 95% CI 1.01 to 4.64) and FLG II (RR 4.5, 95% CI 2.1 to 9.9) were significant risk factors for early pregnancy miscarriages, and FLG II remained as the only independent predictor of miscarriages after adjusting for age, parity, body mass index, blood sugar, blood pressure, and haemoglobin level (adjusted OR 4.2 (95% CI 1.9 to 9.1)).

CONCLUSION

In this rural south Asian community, NAFLD is shown to be a major risk factor for GDM and early pregnancy miscarriages. Therefore, routine identification of NAFLD through a simple USS may help in the early identification of high-risk mothers.

Systematic review with meta-analysis: Non-alcoholic fatty liver disease and the association with pregnancy outcomes

BACKGROUND/AIMS

Maternal and fetal outcomes in pregnant patients with Non-alcoholic fatty liver disease (NAFLD) have been largely unexplored. To determine the level of evidence associated with maternal and fetal outcomes in pregnant women with NAFLD.

METHODS

We conducted a comprehensive literature search. The studies included pregnant patients with a previous, current or subsequent diagnosis of NAFLD. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

Twenty-two studies, with 13,641 female NAFLD patients were reviewed. The results highlight that NAFLD patients had a statistically significant increased likelihood of baseline diabetes mellitus (OR, 6.00; 95% CI, 2.21-16.31; P<0.001; n=7), baseline Hypertension (OR, 3.75; 95% CI, 2.13-6.59; P<0.001; n=4), gestational hypertension (OR, 1.83; 95% CI, 1.03-3.26; P=0.041; n=2), and pre-eclampsia (OR, 2.43; 95% CI, 1.46-4.04; P=0.001; n=3). The odds for a past and current history of gestational diabetes mellitus were OR, 3.78; 95% CI, 2.21-6.44; P<0.001; n=5 and OR, 3.23; 95% CI, 1.97- 5.31; P<0.001; n=6, respectively. As for fetal outcomes, pregnant NAFLD patients were significantly more likely to have a premature birth (OR, 2.02; 95% CI, 1.44-2.85; P<0.001; n=4), large for gestational age birth (OR, 2.01; 95% CI, 1.72-2.37; P<0.001; n=2) or a history of prior miscarriage or abortion (OR, 1.15; 95% CI, 1.02-1.30; P=0.02; n=2). Egger's regression revealed no evidence of publication bias (P>0.05).

CONCLUSION

This meta-analysis provides pooled evidence that NAFLD is associated with a substantial increase in maternal diabetic and hypertensive complications and multiple adverse fetal outcomes. This data is important for clinicians managing these patients before, during and after pregnancy.

The association between parity and metabolic syndrome and its components in normal-weight postmenopausal women in China

BACKGROUND

Studies analyzing the association between parity and normal-weight metabolic syndrome (MetS) in postmenopausal women of normal weight remain limited, this study aimed to explore the association between parity and MetS among Chinese normal-weight postmenopausal women.

METHODS

In total, 776 normal-weight undiagnosed type 2 diabetes postmenopausal women who visited the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University for a routine health check-up between 1 January 2017 and 31 December 2019 were included in the cross-sectional study. All individuals had fully completed information records encompassing standardized electronic medical records, physical examinations, and biochemical measurements. Metabolic health was defined as fewer than 2 parameters of the MetS were present, in combination with normal weight. Continuous variables which were normally distributed were expressed as means and standard deviation. Comparisons among normally distributed continuous variables were made using one-way ANOVA while that among non-normal distribution parameters were made using Kruskal-Wallis. The association between parity and MetS was analyzed using multivariate logistic regression. All of the analyses were performed with SPSS statistical software (Version 23.0, SPSS, Inc., Chicago, IL, USA) and the statistical software package EmpowerStats ( http://www.empowerstats.com , X&Y Solutions, Inc., Boston, MA).

RESULTS

After adjusting for potential confounding factors including hip circumference, parity was failed to show a significantly relationship with MetS in normal-weight women(P=0.054). Women with a higher parity (≥3) had an increased OR of abdominal obesity, while the OR (95% CI) of the parity 3 group was 2.06 (1.13, 3.77) and that of the parity ≥4 group was 3.08(1.42, 6.66) the P for trend was 0.002 after adjusting for potential confounding factors. No significant differences were detected for other metabolic disorders including high levels of triglycerides (TG), blood pressure, fasting plasma glucose (FPG), and decreased high-density lipoprotein cholesterol (HDL-C) in different parity groups.

CONCLUSIONS

Higher parity was not associated with a higher risk of MetS in normal weight Chinese postmenopausal women. As for the components of MetS, only waist circumference was associated with multiparity even after controlling for hip circumference.