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 February 2018 to 31 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.