Gestational Diabetes Associated with Postpartum NAFLD Risk Meta-Analysis: Evidence for Sustained Metabolic Dysfunction Beyond Pregnancy.

Background/Objectives: Gestational diabetes (GD) is a well known risk factor for future metabolic diseases. However, the long-term time-dependent risk of non-alcoholic fatty liver disease (NAFLD) remains unexplored. The aim of this meta-analysis was to quantify the long-term risk of NAFLD in women with previous GD and evaluate if the risk persists beyond the postpartum period. Methods: A systematic search was performed in PubMed using appropriate medical subject headings to identify trials evaluating the incidence of NAFLD among women with previous GD compared to those with normal glucose tolerance (NGT). Studies reporting adjusted risk estimates with a follow-up duration beyond pregnancy were included. Data were extracted and analyzed using relevant statistical methods, with the level of significance at p < 0.05. Results: A total of four studies (N = 2873) were included in the meta-analysis. Women with previous GD had a 2.46-fold higher odds of NAFLD compared to those with NGT (95% CI 1.88-3.23, p < 0.001). The slope for years since delivery was not significant (β = 0.001 per year, 95% CI -0.037 to 0.040, p = 0.901), indicating that the likelihood of NAFLD in women with prior GD did not change over time. Conclusions: GD is associated with a substantially increased and sustained risk of NAFLD, persisting decades beyond pregnancy. These findings identified GD as a potential early risk marker of future liver outcomes and highlight the need for long-term metabolic screening and preventive strategies for this high-risk population.