Hepatic Steatosis Index may predict gestational hypertension and preeclampsia risk

Hepatic Steatosis Index may predict gestational hypertension and preeclampsia risk | Image Credit: © BazziBa - © BazziBa - stock.adobe.com.

There may be a link of Hepatic Steatosis Index (HSI) with gestational hypertension (GH) and preeclampsia (PE) risk, according to a recent study published in the International Journal of Medical Sciences.¹

PE has been linked to liver damage, cardiac and renal insufficiency, and other organ dysfunctions. Hypertension, diabetes, obesity, advanced maternal age, and other factors have been indicated as signs of increased PE risk.²

Data has found a nearly 4-fold increased combined risk of PE and GH in women with non-alcoholic fatty liver disease (NAFLD), which is a leading cause of liver diseases worldwide.¹ Of NAFLD screening methods, the HSI has been proven safe, efficient, and cost-effective.

“An HSI value of 36.0 detects NAFLD with a specificity of 93.1% (95% CI, 92.0-94.0) and a positive likelihood ratio of 6.505 (95% CI, 5.628-7.519),” wrote investigators. “However, data on the relationship between HSI and GH and HSI and PE remain limited.”

Investigators conducted a prospective cohort study to determine the efficacy of HSI for predicting GH and PE. Participants in the China Birth Cohort Study delivering a live-born singleton at Beijing Obstetrics and Gynecology Hospital, Capital Medical University from February 2018 to December 2022 were included in the analysis.

Exclusion criteria included incomplete first-trimester liver enzyme tests, hypertension diagnosed before pregnancy, severe renal diseases or related conditions, and missing covariate data. A standardized questionnaire was used to collect baseline data.

Relevant characteristics included ethnicity, maternal age, employment status, pre-pregnancy height and weight, educational level, gravidity, mode of fertilization, maternal lifestyle factors, medical history, and obstetric history. First-trimester ultrasounds were conducted to determine the date of last menstrual period.

From 6- to 13-weeks’ gestation, laboratory tests were collected after 1 hours of fasting. These included fasting blood glucose, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and γ-glutamyl transferase (GGT).

International Society for the Study of Hypertension in Pregnancy guidelines were used when diagnosing GH and PE. All diagnoses were obtained from medical records after delivery. Participants were categorized in a normal, GH, or PE group.

There were 39,114 participants aged a mean 32 weeks and at a mean 8 weeks’ gestation at baseline included in the final analysis, 4.3% of whom were diagnosed with GH and 4.1% with PE. Higher education levels and natural pregnancy rates were reported among participants in the normal group, while those in the GH and PE groups were more likely to have a higher body mass index.

AST, Alt, and GGT had median overall levels of 14.8 U/L, 12.9 U/L, and 13 U/L, respectively. Significant differences in all serum markers were reported between groups.

GH risk was significantly increased by third of fourth quartiles for ALT and GGT, with odds ratios (ORs) of 1.248 and 1.410, respectively, for the third quartile and 1.610 and 1.847, respectively, for the fourth quartile. Additionally, higher HIS scores vs the first quartile were linked to increased GH risk, with ORs of 1.354, 1.858, and 3.808 for the second, third, and fourth quartiles, respectively.

PE risk was also significantly increased in participants with the highest quartile of AST, with an OR of 1.256. For the third and fourth quartiles of ALT, the ORs were 1.255 and 1.538, respectively. PE risk also significantly increased from the highest quartiles of GGT and HSI, with ORs of 1.978 and 3.602, respectively.

These results indicated an association between elevated HSI in the first trimester with PE and GH risk. A stronger predictive value was also reported in patients aged under 35 years.

“These findings illustrate the importance of NAFLD as a potential risk factor for GH and PE and highlight the need for in-depth research into perinatal primary prevention measures for women with NAFLD,” concluded investigators.

References

1. Zhang L, Gao S, Luan Y.Predictivity of hepatic steatosis index for gestational hypertension and preeclampsia: a prospective cohort study. Int J Med Sci. 2025;22(4):834-844. doi:10.7150/ijms.104943
2. Brown MA, Magee LA, Kenny LC, et al. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy hypertension. 2018;13:291-310.