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Volume 15
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10.3390/jcm15031209
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Systematic Review

Gestational Diabetes Associated with Postpartum NAFLD Risk Meta-Analysis: Evidence for Sustained Metabolic Dysfunction Beyond Pregnancy

by
Milica Stoiljkovic
1,2,*,†,
Katarina Lalic
1,2,
Tanja Milicic
1,2,
Ljiljana Lukic
1,2,
Marija Macesic
1,2,
Jelena Stanarcic Gajovic
1,2,
Mina Milovancevic
1,
Sara Cvijanovic
2,
Djurdja Rafailovic
1,
Stefan Maric
1,
Milica Vujasevic
2,
Nina Krako Jakovljevic
1,
Kasja Pavlovic
1,
Miroslava Gojnic
2,3,
Nebojsa Lalic
2,4,† and
Aleksandra Jotic
1,2,†
1
Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, Doktora Subotica 13, 11000 Belgrade, Serbia
2
Faculty of Medicine, University of Belgrade, Doktora Subotica 8, 11000 Belgrade, Serbia
3
Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Visegradska 26, 11000 Beograd, Serbia
4
Department of Medical Sciences, Serbian Academy of Sciences and Arts, Kneza Mihaila 35, 11000 Belgrade, Serbia
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2026, 15(3), 1209; https://doi.org/10.3390/jcm15031209
Submission received: 29 November 2025 / Revised: 13 January 2026 / Accepted: 16 January 2026 / Published: 4 February 2026
(This article belongs to the Special Issue Navigating Pregnancy and Its Complications: Challenges and Innovations in Maternal–Fetal Medicine)
Versions Notes

Abstract

Background/Objectives: Gestational diabetes (GD) is a well known risk factor for future metabolic diseases. However, the long-term time-dependent risk of non-alcoholic fatty liver disease (NAFLD) remains unexplored. The aim of this meta-analysis was to quantify the long-term risk of NAFLD in women with previous GD and evaluate if the risk persists beyond the postpartum period. Methods: A systematic search was performed in PubMed using appropriate medical subject headings to identify trials evaluating the incidence of NAFLD among women with previous GD compared to those with normal glucose tolerance (NGT). Studies reporting adjusted risk estimates with a follow-up duration beyond pregnancy were included. Data were extracted and analyzed using relevant statistical methods, with the level of significance at p < 0.05. Results: A total of four studies (N = 2873) were included in the meta-analysis. Women with previous GD had a 2.46-fold higher odds of NAFLD compared to those with NGT (95% CI 1.88–3.23, p < 0.001). The slope for years since delivery was not significant (β = 0.001 per year, 95% CI −0.037 to 0.040, p = 0.901), indicating that the likelihood of NAFLD in women with prior GD did not change over time. Conclusions: GD is associated with a substantially increased and sustained risk of NAFLD, persisting decades beyond pregnancy. These findings identified GD as a potential early risk marker of future liver outcomes and highlight the need for long-term metabolic screening and preventive strategies for this high-risk population.
Keywords: gestational diabetes; non-alcoholic fatty liver disease; long-term risk metabolic dysfunction; meta-analysis gestational diabetes; non-alcoholic fatty liver disease; long-term risk metabolic dysfunction; meta-analysis

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MDPI and ACS Style

Stoiljkovic, M.; Lalic, K.; Milicic, T.; Lukic, L.; Macesic, M.; Gajovic, J.S.; Milovancevic, M.; Cvijanovic, S.; Rafailovic, D.; Maric, S.; et al. Gestational Diabetes Associated with Postpartum NAFLD Risk Meta-Analysis: Evidence for Sustained Metabolic Dysfunction Beyond Pregnancy. J. Clin. Med. 2026, 15, 1209. https://doi.org/10.3390/jcm15031209

AMA Style

Stoiljkovic M, Lalic K, Milicic T, Lukic L, Macesic M, Gajovic JS, Milovancevic M, Cvijanovic S, Rafailovic D, Maric S, et al. Gestational Diabetes Associated with Postpartum NAFLD Risk Meta-Analysis: Evidence for Sustained Metabolic Dysfunction Beyond Pregnancy. Journal of Clinical Medicine. 2026; 15(3):1209. https://doi.org/10.3390/jcm15031209

Chicago/Turabian Style

Stoiljkovic, Milica, Katarina Lalic, Tanja Milicic, Ljiljana Lukic, Marija Macesic, Jelena Stanarcic Gajovic, Mina Milovancevic, Sara Cvijanovic, Djurdja Rafailovic, Stefan Maric, and et al. 2026. "Gestational Diabetes Associated with Postpartum NAFLD Risk Meta-Analysis: Evidence for Sustained Metabolic Dysfunction Beyond Pregnancy" Journal of Clinical Medicine 15, no. 3: 1209. https://doi.org/10.3390/jcm15031209

APA Style

Stoiljkovic, M., Lalic, K., Milicic, T., Lukic, L., Macesic, M., Gajovic, J. S., Milovancevic, M., Cvijanovic, S., Rafailovic, D., Maric, S., Vujasevic, M., Krako Jakovljevic, N., Pavlovic, K., Gojnic, M., Lalic, N., & Jotic, A. (2026). Gestational Diabetes Associated with Postpartum NAFLD Risk Meta-Analysis: Evidence for Sustained Metabolic Dysfunction Beyond Pregnancy. Journal of Clinical Medicine, 15(3), 1209. https://doi.org/10.3390/jcm15031209

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