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Gestational Diabetes Research and Management / Liver Disease Diagnosis and Treatment · Journal article
Scientific Reports · August 7, 2026
Encouraging direction, but not yet definitive.
In a prospective cohort of 586 Korean pregnancies, early-pregnancy fatty liver index (FLI) shows a nonlinear dose–response relationship with GDM risk, with a threshold at FLI_log 1.12 above which GDM risk increases substantially (OR = 165.454). Mediation analysis suggests hepatic fat accumulation accounts for 45.2% of the association between pre-pregnancy BMI and GDM, and a significant synergistic interaction exists (RERI = 7.461; AP = 0.785) when both high BMI and elevated FLI are present.
Secondary analysis of prospective cohort study. 586 Korean singleton pregnancies enrolled in prospective cohort.. Intervention: Early-pregnancy fatty liver index (FLI) exposure and pre-pregnancy BMI exposure. Compared with: Nonlinear dose–response relationships and threshold effects modelled; no explicit control group stated. n = 586. Korea (single country).
FLI_log exhibited nonlinear dose–response relationship with GDM risk; threshold identified at 1.12 Above FLI_log threshold of 1.12, GDM risk increased substantially with OR = 165.454 FLI_log accounted for 45.2% of total association between pre_BMI and GDM risk via mediation
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The identification of an FLI_log threshold at 1.12 offers a potential quantitative tool for early GDM risk stratification in Asian pregnant women, particularly those with elevated pre-pregnancy BMI. Recognition of hepatic steatosis as a mediating mechanism (45.2%) suggests that interventions targeting fatty liver may reduce obesity-related GDM risk, supporting precision metabolic management approaches.
Secondary analysis of a prospective cohort identifying a potential mechanistic pathway (hepatic steatosis) linking pre-pregnancy obesity to GDM in an Asian population, with threshold effects and synergistic interactions, but limited by observational design and single-population generalizability.
As stated by the source record.
Quoted from the source exactly as published.
The identification of an FLI_log threshold at 1.12 offers a potential quantitative tool for early GDM risk stratification in Asian pregnant women, particularly those with elevated pre-pregnancy BMI. Recognition of hepatic steatosis as a mediating mechanism (45.2%) suggests that interventions targeting fatty liver may reduce obesity-related GDM risk, supporting precision metabolic management approaches.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Gestational diabetes mellitus (GDM) is a common pregnancy complication with complex metabolic etiology, increasing risks for adverse perinatal outcomes and long-term maternal and offspring health. Pre-pregnancy body mass index (pre_BMI) and hepatic fat accumulation have been implicated in GDM, but their nonlinear associations, threshold effects, and mediation roles remain unclear in Asian populations. In this secondary analysis of a prospective cohort, 586 Korean singleton pregnancies were assessed. Pre_BMI was self-reported by participants before pregnancy, and fatty liver index (FLI) was calculated using blood and anthropometric data collected at 10–14 weeks gestation. GDM was diagnosed via a two-step oral glucose tolerance test at 24–28 weeks. Generalized additive models, segmented regression, mediation, and additive interaction analyses were applied, adjusting for maternal age and parity. Subgroup, sensitivity, and propensity score-matched analyses evaluated robustness. Pre_BMI was positively associated with GDM risk. FLI_log exhibited a nonlinear dose–response relationship with GDM risk, with a threshold identified at 1.12. Above this threshold, GDM risk increased substantially (OR = 165.454). Mediation analysis revealed that FLI_log accounted for 45.2% of the total association between pre_BMI and GDM risk, suggesting that hepatic fat accumulation may represent an important intermediate pathway linking pre-pregnancy obesity to GDM development. Additive interaction analysis further demonstrated a significant synergistic interaction between high pre_BMI and elevated FLI_log (RERI = 7.461; AP = 0.785), indicating an excess risk of GDM when both factors coexisted. These findings remained consistent across subgroup and sensitivity analyses. Early-pregnancy hepatic fat accumulation may partially mediate the association between pre-pregnancy obesity and GDM risk and may further strengthen their combined effect. Identification of the FLI_log threshold provides a potential quantitative indicator for early GDM risk stratification and targeted intervention, offering new insights into the mechanisms underlying obesity-related GDM and supporting precision metabolic management among high-risk Asian pregnant women.
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