Like type 2 diabetes (T2DM), GDM has recently been associated with enhanced hepatic fat deposition. We thus hypothesized that GDM may predict future lifetime risk of serious liver disease, such as cirrhosis, liver failure and transplantation. Using population-based administrative databases, we identified all women in Ontario, Canada, with a live-birth pregnancy between April 1994 and March 2002 (n=698,078). The women were stratified into those who had GDM (n=17,932) and those who did not (n=680,146), and followed for median 17.1 years for the development of serious liver disease (defined by hospitalization for cirrhosis, liver failure or transplantation). Compared to their peers, women with GDM had an elevated risk of this outcome (HR=1.40, 95% CI 1.01-1.94). Since GDM also predicts future risk of T2DM, the women were further stratified based on incident T2DM in the years after delivery (Figure). Women with GDM who developed T2DM (n=8,567) had an elevated risk of serious liver disease (adjusted HR=1.56, 95% CI 1.02-2.39), as did those who did not have GDM but developed T2DM (n=44,148) (adjusted HR=2.48, 95% CI 2.10-2.93). However, there was no increased risk in women with GDM who did not develop T2DM (n=9,365) (adjusted HR=1.15, 95% CI 0.69-1.91). Thus, despite being a diagnosis of young women of childbearing age, GDM predicts future risk of serious liver disease, the development of which may be dependent upon progression to T2DM.
R. Retnakaran: Research Support; Self; Novo Nordisk Inc.. Consultant; Self; Novo Nordisk Inc.. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Consultant; Self; Sanofi, Eli Lilly and Company. J. Luo: None. B.R. Shah: None.