Associations of hepatic steatosis index in early pregnancy with pregnancy outcomes: a prospective birth cohort study

Shaofei Su; Enjie Zhang; Shen Gao; Yue Zhang; Jianhui Liu; Shuanghua Xie; Jinghan Yu; Qiutong Zhao; Wentao Yue; Ruixia Liu; Chenghong Yin

doi:10.1016/j.clinme.2025.100343

Associations of hepatic steatosis index in early pregnancy with pregnancy outcomes: a prospective birth cohort study

Clin Med (Lond). 2025 Jun 27:100343. doi: 10.1016/j.clinme.2025.100343. Online ahead of print.

Authors

Affiliations

¹ Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital. Beijing, China.
² Department of Research Management, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital. Beijing, China.
³ Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital. Beijing, China. Electronic address: yinchh@ccmu.edu.cn.

PMID: 40582621
DOI: 10.1016/j.clinme.2025.100343

Abstract

Background: This study aims to evaluate the association between maternal hepatic steatosis index (HSI) in the first trimester and adverse perinatal outcomes.

Methods: A prospective birth cohort study was conducted from 19^th February 2018 to 31^st December 2022 in China. Logistic regression models and restricted cubic splines were used to estimate the associations of maternal HSI in early pregnancy and the risk of perinatal outcomes. Subgroup analyses stratified by maternal age and gravidity were carried out.

Results: A total of 42,589 participants were included in this study. The overall prevalence of caesarean delivery, preterm birth, large-for-gestational age (LGA), shoulder dystocia and low Apgar scores were 39.17%, 5.18%, 9.45%, 0.92% and 0.77%, respectively. With the increase of HSI quartiles, the incidence of caesarean delivery, preterm birth, large-for-gestational age (LGA) and shoulder dystocia significantly increased (P < 0.0001). The highest quartile of HSI was associated with the highest risk of caesarean delivery (odds ratio [OR] 1.777, 95% CI 1.674-1.886), preterm birth (OR 1.323, 95% CI 1.160-1.510), LGA (OR 2.743, 95% CI 2.468-3.049) and shoulder dystocia (OR 1.487, 95% CI 1.094-2.021). The associations between HSI and adverse perinatal outcomes showed non-linear relationships except for shoulder dystocia (P < 0.0001 for all, P = 0.4792 for non-linearity). Subgroup analyses revealed that the associations between HSI and the risks of LGA and caesarean delivery were significantly stronger in younger and first-time pregnant women.

Conclusion: Elevated maternal HSI in early pregnancy was positively associated with the risk of adverse perinatal outcomes.

Keywords: Hepatic steatosis index; adverse perinatal outcomes; large-for-gestational age; preterm birth; shoulder dystocia.