Steatotic Liver Disease, Clinical Subtypes, and Adverse Perinatal Outcomes: The Prospective Fatty Liver in Pregnancy...

Retrospective global data suggested a possible association of hepatic steatosis with adverse pregnancy outcomes. We sought to prospectively determine the prevalence of steatotic liver disease (SLD) using updated nomenclature and the independent influence of clinically relevant subtypes including metabolic dysfunction-associated steatotic liver disease (MASLD) and lean SLD on pregnancy outcomes.

Using a large prospective screening study of pregnant individuals, we identified SLD prevalence and the clinical subtypes based on updated SLD nomenclature and determined the independent influence of SLD and subtypes on pregnancy and neonatal outcomes.

A total of 1194 pregnant individuals were evaluated for SLD with liver ultrasound at time of second trimester fetal anatomy scan. Among these individuals, 237 (19.8%) were found to have SLD (97% of whom had no prior diagnosis of SLD), of whom 87% met MASLD criteria. Independent associations were identified between SLD with gestational hypertension (odds ratio [OR], 1.52; 95% confidence interval [CI], 1.01-2.26) and very preterm delivery (OR, 3.95; 95% CI, 1.10-14.17); and between grade 2/3 (moderate to severe) SLD with gestational diabetes (OR, 2.37; 95% CI, 1.06-4.96); and lean SLD (body mass index ≤25/(≤23 if Asian) kg/m² with small for gestational age neonates (OR, 3.54; 95% CI, 1.33-8.52).There were no significant associations with preeclampsia.

MASLD was frequent among previously undiagnosed individuals during pregnancy. Individualized counseling and pregnancy management based on presence and SLD subtype may aid in optimizing pregnancy outcomes.