CLINICAL CHARACTERISTICS OF NON-ALCOHOLIC FATTY LIVER DISEASE IN PREGNANT WOMEN WITH VARYING DEGREES OF OBESITY
DOI:
https://doi.org/10.11603/24116-4944.2021.2.12606Keywords:
nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, obesity, body mass index, clinic, pregnancyAbstract
The aim of the study – to evaluate the functional status of the liver in pregnant women with NAFLD in pregnant women depending on body mass index.
Materials and Methods. Weʼve examined 98 pregnant women with NAFLD at the stage of NASH in combination with obesity. The age of the examined women ranged from 21 to 35 years (mean age 30.5 ± 1.5 years). The control group consisted of 30 almost healthy pregnant women. Depending on the body mass index (BMI), all surveyed women are divided into three groups: Group I - overweight pregnant women, Group II - pregnant women with grade I obesity, Group III - pregnant women with grade II obesity. The main clinical and biochemical syndromes (asthenic, dyspeptic, pain, cytolytic, cholestatic, mesenchymal-inflammatory, hepatocellular insufficiency) were evaluated.
Results and Discussion. During the non-invasive diagnostics of the liver we revealed a tendency to increase the degree of steatosis in the examined groups depending on the increasing the body mass index. According to the results of the Steato-test, the highest rate was observed in women of group III, which was 1.38, 1.2 and 4.2 times higher than the results of the examined pregnant women of groups I and II and the control group (p<0.05). At the same time, NASH-test data among pregnant women with NASH on the background of grade II-III obesity exceeded 1.54 times the data obtained among women of group I, 1.11 times among patients of group II and 4.5 times the results among control group (p<0.05).
When comparing the clinical manifestations of NAFLD in pregnant, the highest frequency is observed in the group of examined women with severe obesity compared with the group of patients with moderate obesity and overweight: symptoms of asthenic syndrome (increased fatigue, sleep disturbances, emotional lability, decreased and increased appetite) in 91.6.0 %, 79.1 % and 61.5 % of patients (p<0.05), manifestations of dyspepsia (constipation, nausea, flatulence) - in 87.5 %, 54 % and 34.6 % patients (p<0.05), feeling of heaviness or moderate pain in the right hypochondrium - in 62.5 % 50 % and 30.7 % of patients, respectively (p<0.05).
Conclusions. It has been established that pregnant women on the background of obesity have pronounced clinical manifestations of the NAFLD, which depends on the increase in BMI. It was found that in pregnant women with NAFLD liver dysfunction occurs on the background of grade I obesity, which can be considered as an early marker of steatohepatitis.
References
Hershman, M., Mei, R., & Kushner, T. (2019). Implications of nonalcoholic fatty liver disease on pregnancy and maternal and child outcomes. Gastroenterol. Hepatol. (N Y)., 15 (4), 221-228.
Denisov, N., Grinevich, V., Chernetcova, E., Kornouchova, L., Kravchuk, U., Partsernyak, S., & Mironenko, A. (2017). Nealkoholna zhyrova khvoroba pechinky yak novyi komponent metabolichnoho syndromu u svitli suchasnykh metodiv diahnostyky [Non-alcoholic fatty liver disease as a new component of the metabolic syndrome in the light of modern methods of diagnosis]. Visnyk Pivnichno-Zakhidnoho derzhavnoho medychnoho universytetu im. Mechnykova – Herald of North-Western State Medical University named after I.I. Mechnikov, 9, 34-41. DOI: 10.17816/mechnikov20179134-41 [in Ukrainian].
Jain, D., Khuteta, R., Chaturvedi, V., & Khuteta, S. (2012). Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies: observational study. J. Obstet. Gynaecol. India, 62 (4), 429-431. DOI: 10.1007/s13224-012-0225-x.
Polyzos, S.A, Kountouras, J., & Mantzoros, C.S. (2019). Obesity and nonalcoholic fatty liver disease: From pathophysiology to therapeutics. Metabolism, 9 (2), 82-97. DOI: 10.1016/j.metabol.2018.11.014.
Dumolt, J.H., Browne, R.W., Patel, M.S., & Rideout, T.C. (2019). Malprogramming of hepatic lipid metabolism due to excessive early cholesterol exposure in adult progeny. Mol. Nutr. Food Res., 63 (2), e1800563. DOI: 10.1002/mnfr.201800563
Makarov, I.O., Borovkov, E.I., & Kazakov, R.D. (2012). Prevalence of non-alcoholic fatty liver disease among obese pregnant women. Obstet. Gynecol. Reprod., 6 (4), 18-21.
Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., …, & Gakidou, E. (2014). Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet., 384 (9945), 766-781. DOI: 10.1016/S0140-6736(14)60460-8.
Kulie, T., Slattengren, A., JackieRedmer, J., Counts, H., Eglash, A., & Schrager, S. (2011). Obesity and womenʼs health: an evidence-based review. J. Am. Board Fam. Med., 24 (1), 75-85. DOI: 10.3122/jabfm.2011.01.100076.
Vilar-Gomez, E., Calzadilla Bertot, L., Wai-Sun Wong, V., Castellanos, M., Aller-de la Fuente, R., Metwally, M., ..., & Romero-Gomez, M. (2018). Fibrosis severity as a determinant of cause-specific mortality in patients with advanced nonalcoholic fatty liver disease: a multi-national cohort study. Gastroenterology, 155 (2), 443-457. DOI: 10.1053/j.gastro.2018.04.034.
Younossi, Z.M, Koenig, A.B, Abdelatif, D., Fazel, Y., Henry, L., & Wymer, M. (2016). Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology, 64 (1), 73-84. DOI: 10.1002/hep.2843.
Hamaguchi, M., Kojima, T., Takeda, N., Nakagawa, T., Taniguchi, H., Fujii, K., ..., & Ida, K. (2005). The metabolic syndrome as a predictor of nonalcoholic fatty liver disease. Ann. Intern. Med., 143 (10), 722-728. DOI: 10.7326/0003-4819-143-10-200511150-00009.
Younossi, Z., Stepanova, M., Ong, J.P., Jacobson, I.M., Bugianesi, E., Duseja, A., …, & Afendy, A. (2019). Nonalcoholic steatohepatitis is the fastest growing cause of hepatocellular carcinoma in liver transplant candidates. Clin. Gastroenterol. Hepatol., 17 (4), 748-755. DOI: 10.1016/j.cgh.2018.05.057.
Allen, A.M., Therneau, T.M., Larson, J.J., Coward, A., Somers, V.K., & Kamath, P.S. (2018). Nonalcoholic fatty liver disease incidence and impact on metabolic burden and death: a 20 year-community study. Hepatology., 67 (5), 1726-1736. DOI: 10.1002/hep.29546.
Doycheva, I., Issa, D., Watt, K.D., Lopez, R., Rifai, G., & Alkhouri, N. (2018). Nonalcoholic steatohepatitis is the most rapidly increasing indication for liver transplantation in young adults in the United States. J. Clin. Gastroenterol., 52 (4), 339-346. DOI: 10.1097/MCG.0000000000000925.
Bogomolov, P.O., & Tsodikov, G.V. (2006). Nealkogolnaya zhirovaya bolezn pecheni [Non-alcoholic fatty liver disease]. Consilium Medicum, 1, 7-8 [in Russian].
Farrell, G.C. (2009). The liver and the waistline: Fifty years of growth. J. Gastroenterol. Hepatol., 24 (3), 105-118. DOI: 10.1111/j.1440-1746.2009.06080.
Kutchi, I., Chellammal, P., & Akila, A. (2020). Maternal obesity and pregnancy outcome: in perspective of new asian indian guidelines. J. Obstet. Gynecol. India., 70 (2), 138-144. DOI: 10.1007/s13224-019-01301-8.
Hashimoto, E., Taniai, M., & Tokushige, K. (2013). Characteristics and diagnosis of NAFLD/NASH. J. Gastroenterol. Hepatol., 28 (4), 64-70. DOI: 10.1111/jgh.12271.
Noureddin, M., Vipani, A., Bresee, C., Todo, T., Kim I. K., & Alkhouri, N. (2018). NASH leading cause of liver transplant in women: updated analysis of in- dications for liver transplant and ethnic and gender variances. Am. J. Gastroenterol., 113 (11), 1649-1659. DOI: 10.1038/s41395-018-0088-6.
Chalasani, N., Younossi, Z., Lavine, J.E, Charlton, M., Cusi, K., Rinella, M., & Sanyal, A.J. (2018). The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology., 67 (1), 328-357. DOI: 10.1002/hep.29367.
Sarkar, M., Grab, J., Dodge, J.L, Gunderson, E.P, Rubin, J., Irani, R.A., ..., & Terrault, N. (2020). Non-alcoholic fatty liver disease in pregnancy is associated with adverse maternal and perinatal outcomes. J. Hepatol., 73 (3), 516-522. DOI: 10.1016/j.jhep.2020.03.049.
Mosca, A., Panera, N., Maggiore, G., & Alisi, A. (2020). From pregnant women to infants: Non-alcoholic fatty liver disease is a poor inheritance. J. Hepatol., 73 (6), 1590-1592. DOI: 10.1016/j.jhep.2020.06.043.
Lao, T.T. (2020). Implications of abnormal liver function in pregnancy and non-alcoholic fatty liver disease. Best. Pract. Res. Clin. Obstet. Gynaecol., 68, 2-11. DOI: 10.1016/j.bpobgyn.2020.02.011.
Leng, J., Zhang, C., Wang, P., Li, N., Li, W., & Liu, H. (2016). Plasma levels of alanine aminotransferase in the first trimester identify high risk Chinese women for gestational diabetes. Sci. Rep., 6, 27291. DOI: 10.1038/srep27291.
Vernon, G., Baranova, A., & Younossi, Z.M. (2011). Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment. Pharmacol. Ther., 34 (3), 274-285. DOI: 10.1111/j.1365-2036.2011.04724.x.
Leuschner, U., James, O.F.W., & Dancygier, H. (Eds.). (2001). Diagnosis of non-alcoholic steatohepatitis. Steatohepatitis (NASH and ASH). Dordrecht: Kluwer Academic Publishers.
Sridhar, S.B., Xu, F., Darbinian, J., Quesenberry, C.P., Ferrara, A., & Hederson, M. M. (2014). Pregravid liver enzyme levels and risk of gestational diabetes mellitus during a subsequent pregnancy. Diabetes Care, 37 (7), 1878-1884. DOI: 10.2337/dc13-2229.
Sattar, N., Forrest, E., & Preiss, D. (2014). Non-alcoholic fatty liver disease. Br. Med. J., 349, g4596. DOI: 10.1136/bmj.g4596.
Rinella, M., & Charlton, M. (2016). The globalization of nonalcoholic fatty liver disease: prevalence and impact on world health. Hepatology, 64 (1), 19-22. DOI: 10.1002/hep.28524.
Asimuakopoulos, G. (2006). Pregnancy and liver disease. Rev. Med. Chir. Soc. Med. Nat. Iasi., 110 (2), 326-333.
Mousa, N., Abdel-Razik, A., Shams, M., Sheta, T., Zakaria, S., Shabana, W., ..., & Eldars, W. (2018). Impact of non-alcoholic fatty liver disease on pregnancy. Br. J. Biomed. Sci., 75 (4), 197-199. DOI: 10.1080/09674845.2018.1492205.
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