The principal findings of this study were: (1) in this cohort, the frequency of LGA was 10.9% (68/623) and of NAFLD was 18.9%; (2) the risk of LGA increased significantly in patients with Grade 2–3 steatosis in the first trimester; (3) the relationship between Grade 2–3 steatosis and LGA remained significant after adjustment for age, pre-gestational BMI, GDM, maternal serum triglyceride levels, and HOMA-IR; and (4) levels of adiponectin in the maternal circulation were significantly lower in women who delivered an LGA neonate, even at the time of 10–14 weeks of gestation. Here, ADIPOQ is linked to metabolic dysfunction-associated steatotic liver disease.