Association Between Nonalcoholic Fatty Liver Disease And Gestational Diabetes Mellitus:Meta-Analysis

BackgroundNonalcoholic fatty liver disease(NAFLD)and gestational diabetes mellitus(GDM)are two of the common types of endocrinopathies during pregnancy.In recent years,more and more research results show that there is a certain correlation between NAFLD and the occurrence of GDM.NAFLD may be an independent predictor in the pathogenesis of GDM,but these studies are mostly single observational studies,the intensity of the causality is relatively low,and the results of a single study do not reliably to reveal the relationship between GDM and NAFLD.It is still unclear that whether there is a bidirectional relationship between them,and there is still a lack of evidence based evidence-based medical evidence to reveal the relationship.Therefore,we collect relevant literature on the relationship that have been published abroad to conduct the Meta-analysis.ObjectiveTo observe the relationship between NAFLD and GDM by Meta-analysis.MethodsAccording to the Cochrane system evaluation method,we searched all the published literature on NAFLD and GDM from January 1980 through March 2017 using PubMed,the Cochrane library and EMBASE,language is limited to English.Through the literature screening,2 endocrinology researchers were independent to conduct the data extraction and quality evaluation that were in conformity with the inclusion criteria.Then meta-analysis was performed using Rev Man 5.3 software to calculated relative risk(RRs)and 95%confidence intervals(CIs).The results of the meta-analysis were displayed in the forest plots,and a sensitivity analysis was also conducted to investigate sources of heterogeneity by sequentially removing individual studies,and we generated a funnel plot to explore the presence of publication bias.In addition,the degree of heterogeneity(I~2)statistics are used to evaluate the heterogeneity among studies.ResultsA total of 1712 relevant literatures were retrieved,8 articles met the inclusion criteria after screening.Review the methodology quality of each article by using Newcastle-Ottawa Scale(NOS),8 articles with a high quality of 7-8 points.Meta-analysis of 5 studies(outcome1)totalling 3608 participants showed a significantly increased prevalence of GDM in patients with NAFLD,(RR=2.56,95%CI:1.81-3.62),with a statistically significant difference,P<0.01.After adjustment for potential confounders,the I~2 was 15%.In a parallel analysis,sensitivity tests of three studies involving 1449 women revealed a lack of consistency in the data(outcome2).Due to limited sample sizes,the significance was null,(RR=1.40,95%CI:0.43-4.53,I~2=91%,P=0.58).Considering the limited number of included studies,the results of sensitivity analysis showed that the data were lack of consistency and the difference was not statistically significant.ConclusionOur meta-analysis produced data showing a bi-directional relationship between NAFLD and GDM.In particular,patients with NAFLD had a greater risk of developing GDM.Women with a history of GDM have a higher odds of developing NAFLD.This scientific evidence reveals that a targeted strategy can be provided to prevent the incidence of NAFLD and GDM related diseases.The results of this study may have a potential wide impact on public health.In order to get more authentic evidences of evidence-based medicine,more clinical studies with large samples,standardized,comprehensive and multicenter high quality are needed to verify the results of this study.