The risk of pregnancy‐associated hypertension in women with nonalcoholic fatty liver disease

Background & Aims Nonalcoholic fatty liver disease (NAFLD) is an independent predictor of cardiovascular disease (CVD) in non‐pregnant adults. Although the biological mechanisms underlying this association are not completely understood, metabolic factors, inflammation, and endothelial dysfunction are likely all involved. The association between NAFLD and pregnancy‐associated hypertension (HTN) has not been systematically examined. The aim of this study is to assess the risk of pregnancy‐associated HTN in pregnant women with NAFLD. Methods This is secondary analysis of a prospective study of healthy pregnant women. Liver ultrasonography was performed at 10‐14 weeks of gestation and maternal blood was taken for the measurement of selenoprotein P (SeP), a hepatokine independently associated with both NAFLD and CVD. Pregnancy‐associated HTN was defined as the development of gestational HTN, preeclampsia, or eclampsia. Results Among 877 pregnant women, the risk of developing pregnancy‐associated HTN was significantly increased in women with NAFLD compared to those without NAFLD. Grade 2‐3 steatosis was a significant predictor of pregnancy‐associated HTN, even after adjustment for metabolic risk factors. Circulating levels of SeP were significantly higher in women with versus those without NAFLD (P = .001) and was significantly higher also in women who subsequently developed pregnancy‐associated HTN compared with those who did not (P