Effects of Gestational Diabetes Mellitus on Fetal Liver Length: A Systematic Review and Meta-Analysis

Sahar Ardalan  Khales; Abdolhalim  Rajabi; Masoud  Golalipour; Gholamreza  Roshandel; Mohammad Jafar  Golalipour

doi:10.18502/ijph.v54i2.17903

Sahar Ardalan Khales Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
Abdolhalim Rajabi Environmental Health Research Center, Department of Biostatistics and Epidemiology, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
Masoud Golalipour Medical Cellular and Molecular Research Centre, Golestan University of Medical Sciences, Gorgan, Iran
Gholamreza Roshandel Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
Mohammad Jafar Golalipour Gorgan Congenital Malformations Research Center, Golestan University of Medical Sciences, Gorgan, Iran

DOI: https://doi.org/10.18502/ijph.v54i2.17903

Keywords: Fetus; Gestational diabetes mellitus; Liver; Meta-analysis

Abstract

Background: Gestational diabetes mellitus (GDM) is a serious pregnancy complication that can affect various organs and organ systems of the mother and fetus. In diabetic mothers, increased blood glucose delivery to the fetus leads to fetal hyperglycemia and hyperinsulinemia, which promotes the growth of insulin-dependent organs such as the liver. Therefore, this systematic review and meta-analysis was conducted to more precisely estimate the association between GDM and fetal liver length (FLL).

Methods: Six electronic databases (PubMed, Scopus, Web of Science, ProQuest, Cochrane, and Wiley) were searched up to Aug 2023. Two reviewers independently extracted data and assessed the risk of bias using the Newcastle–Ottawa Scale. The pooled weighted and standardized mean differences in FLL were calculated using random-effects models. Heterogeneity, subgroup analysis, and publication bias were also assessed using funnel plots. All statistical analyses were performed using Stata Version 16.0.

Results: Twelve articles were included in the final meta-analysis. GDM was associated with increased FLL, as assessed by ultrasound, in both the second (SMD=1.56; 95% CI: 1.04, 2.08; P<0.001) and third (SMD=0.84; 95% CI: 0.07, 1.61; P<0.001) trimesters of pregnancy. The pooled mean difference in FLL between the GDM and non-GDM groups was 4.85 mm (WMD=4.85; 95% CI: 3.26, 6.45), indicating larger liver size in fetuses from mothers with GDM.

Conclusion: GDM is a significant risk factor for increased FLL, as assessed by ultrasound, which may reflect fetal overgrowth and metabolic dysfunction.