Metabolic Dysfunction-Associated Steatotic Liver Disease in Pregnancy

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly nonalcoholic fatty liver disease, is the most common liver condition in the United States and the leading cause of cirrhosis. MASLD is closely associated with cardiovascular diseases and shares risk factors such as obesity, hypertension, and insulin resistance. Commonly seen in pregnant women, MASLD has an estimated prevalence of 10% worldwide.

For many women of childbearing age, pregnancy may be the only link to medical care, presenting a critical opportunity to diagnose MASLD. It is paramount to raise awareness among obstetrician-gynecologists of the risk factors and pregnancy-related complications arising from MASLD development.

Data were obtained from a review of liver and obstetric and gynecological clinical practice guidelines. Relevant keyword searches encompassing MASLD and pregnancy in PubMed were conducted to survey literature in the English language.

MASLD is independently associated with obstetric complications and adverse outcomes for both mother and fetus. Maternal complications include gestational diabetes mellitus, gestational hypertension, and preeclampsia, whereas fetal complications include preterm birth and large-for-gestational-age infants. Multiple studies demonstrate that dietary and exercise-related interventions to curb gestational weight gain, coupled with behavioral therapy, significantly reduce adverse maternal and neonatal outcomes.

The presence of predisposing risk factors in the pregnant patient should prompt screening for MASLD. If MASLD is diagnosed, interventions to mitigate pregnancy-related complications are indicated. Ultimately, referral of the pregnant patient with MASLD for risk stratification and management is suggested to avoid future liver or cardiovascular-related morbidity.