SUN-529 - Postpartum Metabolic Dysfunction-Associated Steatotic Liver Disease in Mexican Women with Prior Gestational Diabetes Mellitus

Background
Although previous evidence suggests a bidirectional association between gestational diabetes mellitus (GDM) and metabolic dysfunction-associated steatotic liver disease (MASLD), ethnicity-specific information on the risk of MASLD in postpartum women with prior GDM using transient elastography is limited. The Mexican population shows a high prevalence of both MASLD and GDM, potentially increasing metabolic risk. Thus, we aimed to determine the risk of developing MASLD in Mexican women with and without prior GDM at two years post-partum.

Methods
Adult women with and without prior GDM (diagnosed using the one-step algorithm at 24-28 pregnancy weeks) were evaluated post-delivery. The data included demographics, clinical characteristics, body composition analysis by bioelectrical impedance (Inbody 370s), a Fibroscan test (Fibroscan 530 Compact, Echosens) to determine CAP score (dB/m), and biochemical blood testing for fasting plasma glucose, triglycerides, and liver enzymes. Adjusted odds ratios (ORs) and 95% CI were estimated for the risk of MASLD in women with prior GDM using multivariable logistic regression analysis.

Results
A total of 162 Mexican women (31.6 + 7 years) were included, comprising 51% (83/162) with prior GDM. Participants with a history of GDM had higher and significantly different BMI, body fat percentage (BFP), fasting plasma glucose, and triglyceride levels during postpartum evaluation. Liver enzymes (AST and ALT) and FAST score were within the normal range and did not differ between the groups. Tertiles of the CAP score (T1 < 261 dB/m, T2= 261-291.2 dB/m, T3> 291.1 dB/m) revealed a higher proportion of women with prior GDM in the upper tertile compared to controls (GDM 39.7% vs. non-GDM 26.5%), indicating more severe steatosis. In addition, categorization of women in both groups by tertile distribution of the CAP score showed a significant difference (p>0.04). Two years after delivery, based on transient elastography results, 66% of the women had MASLD with a significant difference in prevalence between the groups (GDM 74.6% vs. non-GDM 55.6%, p= 0.01), considering T2 cutoff (> 261 dB/m). Only two women with previous GDM had fibrosis (F2). According to the adjusted logistic regression analysis, GDM was independently associated with MASLD (Ref T1, OR 2.25, 95% CI 1.03-5.06, p=0.04).

Conclusion
The prevalence of MASLD was high in this cohort of young Mexican women with overweight and obesity within two years postpartum. Previous GDM independently doubles the risk of MASLD, highlighting the need for screening and interventions among Hispanic women.

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