Expectant mothers with metabolic dysfunction-associated fatty liver disease (MASLD) face a more than threefold higher risk of delivering prematurely, even after accounting for obesity, family health history and liver disease severity, according to study findings were published in EClinicalMedicine.

“This suggests that the association is not only due to a high [body mass index] and that the liver disease itself can have negative effects,” lead author Carole Marxer, PhD, of the Karolinska Institute in Stockholm, said in a news release. “It is important that pregnant women with MASLD are closely monitored during pregnancy to reduce the risk of complications. Consideration should also be given to adding specific recommendations for pregnant women to the clinical guidelines for MASLD.”

MASLD and its more severe form, metabolic dysfunction-associated steatohepatitis (MASH), are responsible for a growing proportion of advanced liver disease worldwide. Over time, the buildup of fat in the liver can lead to fibrosis, cirrhosis and liver cancer.

Linked to obesity and diabetes, MASLD is expected to rise dramatically over the next 30 years, with cases of decompensated cirrhosis more than tripling, liver cancer nearly doubling and liver transplants increasing almost fourfold, according to projections recently published in JAMA Network Open. With only one approved medication, fatty liver disease management largely relies on lifestyle changes such as weight loss and exercise.

While MASLD has been linked to worse clinical outcomes during pregnancy, the impact of obesity, family history and severity of fatty liver disease has not been well studied. To learn more, Marxer and colleagues conducted a nationwide cohort study in Sweden. A total of 162 women with MASLD, who accounted for 240 births, were matched with 1,138 women without MASLD, who had 1,140 births.

Mothers with MASLD had more than a threefold higher risk of preterm birth, irrespective of obesity and factors such as genetics or environmental exposures. Some 17% of women with MASLD gave birth to preterm babies compared to less than 5% in the matched general population. However, having more severe MASLD was not linked to a greater risk for preterm birth.

Women with MASLD had a 63% increased risk of undergoing caesarean section compared with the matched group. But in this case, high body mass index was likely to blame, since women without MASLD with overweight or obesity also had a similar additional risk. In more encouraging news, women with MASLD did not have more stillbirths, neonatal deaths or babies with birth defects.

“This key finding may influence the European and American clinical practice guidelines for managing MASLD in pregnancy, which currently recommend monitoring risks related to obesity and diabetes (risk factors of MASLD),” wrote the researchers. “The latest suggestion may be revised to recommend monitoring risks associated with MASLD itself and to prompt changes in preconception counseling.”

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