Nonalcoholic Steatohepatitis (NASH) and Nonalcoholic Fatty Liver Disease (NALFD) in Pregnancy: A Narrative Review

Nonalcoholic steatohepatitis/nonalcoholic fatty liver disease (NASH/NALFD) is coupled with a substantial risk of morbidity and mortality and is increasingly identified as a comorbidity in pregnancy. Information about the effect of NAFLD on pregnancy and perinatal outcomes is incomplete.

This review examines the etiology, pathophysiology, risk factors, diagnosis, management, maternal and perinatal outcomes, and recurrence risk in pregnancies complicated by NASH/NALFD.

Electronic databases searched were (PUBMED and Embase). The search terms used were "pregnancy" OR "perinatal care" AND "nonalcoholic steatohepatitis" OR "NASH" OR "NALFD" OR "nonalcoholic fatty liver disease. The search was limited to the English language, but not to the years searched.

There were 515 abstracts identified, of which 73 are the basis of this review. NAFLD is seen as the hepatic manifestation of the metabolic syndrome (abdominal obesity, low HDL cholesterol, elevated fasting glucose, overweight/obese body mass index). The overall prevalence among pregnant women with NAFLD from a large prospective study was 14%. Consistent risk factors of NAFLD in pregnancy include prepregnancy obesity, metabolic syndrome, type 2 diabetes, and polycystic ovarian syndrome. Diagnosis is confirmed by steatosis, ballooning, and inflammation on liver biopsy. Treatment is primarily weight reduction and lifestyle modifications. Maternal complications during pregnancy include gestational diabetes, hypertension, cesarean delivery, postpartum hemorrhage, and congestive heart failure. Fetal complications include spontaneous abortion, fetal growth restriction, large-for-gestational-age neonates, and preterm birth.

The increase in NAFLD in pregnancy parallels the increase in maternal obesity and metabolic syndrome. Unfavorable pregnancy outcomes include hypertensive disorders of pregnancy, cesarean delivery, postpartum hemorrhage, congestive heart failure, early pregnancy losses, fetal growth restriction, large neonates, and preterm deliveries. Management primarily consists of weight reduction and lifestyle modifications.

The escalating rate of overweight or obese women who become pregnant and the neonates of these women, both of which are being diagnosed with NAFLD at an increasing rate, is very worrisome. Particularly since our only current treatment is weight reduction and lifestyle modifications, neither of which, to date, has been very successful in maternal weight reduction.