Maternal Obesity Tied to NAFLD in Offspring

By Lisa Rapaport

August 16, 2021

(Reuters Health) - Pregnant women with obesity are more likely than normal-weight pregnant women to have children who develop non-alcoholic fatty liver disease (NAFLD), a Swedish study suggests.

Researchers examined data on 165 youth with biopsy-confirmed NAFLD diagnosed between 1992 and 2016 before age 26 as well as 717 controls without NAFLD from the general population who were matched by age, sex and birth year.

From a national database, the researchers also had information about mothers' body mass index (BMI) during early pregnancy

People with NAFLD were more likely to have mothers with obesity during pregnancy than their peers in the general population (19.3% vs 8.4%; adjusted odds ratio, 3.26).

There was also an increased risk when mothers had overweight, but this wasn't statistically significant.

Severe NAFLD involving cirrhosis or fibrosis confirmed by biopsy was also significantly more common among offspring of mothers with overweight (aOR 1.94) or obesity (aOR 3.67).

NAFLD was significantly more common among offspring of mothers who smoked at least 10 cigarettes a day (aOR 2.13) compared with mothers who didn't smoke, the study also found. Mothers with less than 10 years of completed education were also more likely to have offspring with NAFLD (aOR 2.22) but this association wasn't statistically significant.

The impact of maternal obesity on offspring NAFLD risk appeared greater for male children (aOR 4.22) than for female children (aOR 2.87), the study also found.

The association of NAFLD with maternal obesity "could be due to biological changes in utero, as suggested by previous preclinical mouse models, or socioeconomics and adopting a sedentary lifestyle with excess caloric intake, or a combination," said study leader Dr. Hannes Hagström of the Karolinska Institutet in Stockholm.

It's unclear from the study exactly how to prevent offspring NAFLD, but the results suggest that public health efforts to prevent obesity might help, Dr. Hagström said by email.

"There are several ways to accomplish that, but it would require political decisions such as measures to reduce refined sugar intake and making it easier for consumers to select healthy food options, as well as increasing options for physical mobility such as bike commuting to work," Dr. Hagström said. "The same measures are likely to also be beneficial for children to mother with a high BMI, and individual choices could mirror these public health recommendations."

Because the study included only offspring with biopsy-confirmed NAFLD, the cases might have been more severe than average cases in the community, the study team notes in the Journal of Hepatology. The researchers also lacked data on the indication for liver biopsies and relied on administrative claims data for information on disease severity.

Even so, the study appropriately acknowledges that diet, lifestyle, and the social determinants of health that impact the mother will also impact her children, said Dr. Veeral Ajmera, an associate professor of medicine and Medical Director of Liver Transplantation at the University of California, San Diego.

"While the genetic component of risk may not be modifiable, pregnancy may represent an opportunity for clinicians to focus on education on a healthy diet and lifestyle to avoid future health problems for pregnant women and their offspring," Dr. Ajmera, who wasn't involved in the study, said by email.

SOURCE: Journal of Hepatology, online July 18, 2021.