Maternal Liver Shear Wave Elastography in Pregnancies Complicated by Gestational Diabetes Mellitus: A Prospective Study

Background: Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcomes. Recent advances in imaging have introduced shear wave elastography (SWE) as a non-invasive method for evaluating soft tissue stiffness. This study aimed to assess maternal liver stiffness using SWE in pregnancies with and without GDM and evaluate its potential utility in GDM risk stratification. Methods: This prospective observational study included 130 women with singleton pregnancies between 24 and 28 weeks’ gestation. All participants underwent a 75 g oral glucose tolerance test (OGTT) and were categorized into GDM (n = 65) or non-GDM (n = 65) groups based on ADA/IADPSG criteria. Liver stiffness was measured transabdominally using SWE targeting segment 8 of the right hepatic lobe. Five measurements were obtained per participant, and the median value was used for analysis. Liver stiffness values were classified based on established hepatology thresholds. Demographic, biochemical, and elastographic variables were compared between groups. Correlation and receiver operating characteristic (ROC) analyses were performed to assess associations and diagnostic performance. Results: Mean body mass index was significantly higher in the GDM group (30.3 ± 2.3 kg/m²) than in the non-GDM group (24.5 ± 2.3 kg/m²) (p < 0.001). Liver stiffness was also significantly elevated in women with GDM (6.17 ± 0.87 kPa vs. 5.63 ± 0.61 kPa, p < 0.001). Stiffness values ≥ 6.1 kPa (suggestive of fibrosis) were observed in 61.5% of GDM and 23.1% of non-GDM cases (p < 0.001). SWE values correlated positively with fasting glucose (r = 0.173) and LDL cholesterol (r = 0.199), and inversely with HDL cholesterol (r = − 0.226). ROC analysis identified a cut-off value of 5.79 kPa (AUC: 0.699), with 61.5% sensitivity and 72.3% specificity for predicting GDM. Conclusions: Maternal liver stiffness is significantly increased in GDM and shows moderate discriminative power during OGTT screening. SWE may serve as a useful adjunct for non-invasive metabolic assessment in pregnancy.