MASLD in pregnancy tied to higher risk of premature birth: Study
Babies of moms with this fatty liver disease not more prone to birth defects
Women with metabolic dysfunction-associated steatotic liver disease (MASLD), a form of fatty liver disease, are more likely to give birth prematurely, but their babies are not more likely to have birth defects, according to a nationwide study conducted in Sweden.
Importantly, while people with MASLD are often obese, the data suggest the increased risk of premature birth in pregnant MASLD patients is not attributable to obesity.
“This suggests that the association is not only due to [being overweight or obese] and that the liver disease itself can have negative effects,” Carole Marxer, PhD, the study’s first author at Karolinska Institutet in Sweden, said in an institute press release. “It is important that pregnant women with MASLD are closely monitored during pregnancy to reduce the risk of complications.”
The study, “Adverse pregnancy and birth outcomes in women with biopsy-proven MASLD: a nationwide cohort study,” was published in eClinicalMedicine.
Women with MASLD more than three times as likely to give birth prematurely
In MASLD, fat builds up in the liver of people who typically have risk factors such as diabetes, high blood pressure, and/or obesity.
Previous studies have suggested pregnant people with MASLD are more likely to experience pregnancy complications like gestational diabetes and preeclampsia, a condition marked by high blood pressure.
However, these issues are generally more common in people who are obese, and because MASLD patients are often obese, it’s been difficult to differentiate the effects of MASLD from the effects of obesity.
In this nationwide study, a team of researchers in Sweden assessed how MASLD in pregnancy affects birth outcomes and evaluated the potential role of being overweight or obese. They compared outcomes from 240 births to people with MASLD against those from 1,140 births to people who did not have MASLD (used as controls).
Results showed pregnant women with MASLD were more than three times as likely to give birth prematurely (before 37 weeks of gestation) than controls. This significant association was observed for medically recommended preterm birth (a nearly 12 times higher chance) and spontaneous preterm birth (a twofold higher chance).
“This nationwide study of pregnant women with MASLD confirms that MASLD should be regarded as a high-risk obstetric condition, carrying significant implications for pregnancy care,” the researchers wrote.
Marxer added that “consideration should also be given to adding specific recommendations for pregnant women to the clinical guidelines for MASLD,” Marxer said.
This nationwide study of pregnant women with MASLD confirms that MASLD should be regarded as a high-risk obstetric condition, carrying significant implications for pregnancy care.
The risk of premature birth did not increase with MASLD severity, but remained significantly higher even when compared with that of overweight or obese women without MASLD — implying obesity alone doesn’t account for this increase in risk.
“MASLD was associated with a higher risk of preterm birth, independent of obesity,” the researchers wrote. Marxer said this suggests “the liver disease itself can have negative effects.”
Women with MASLD were also significantly more likely, by 63%, to give birth by cesarean section (C-section) compared with controls. However, C-section rates were comparable to those of overweight or obese women without MASLD, suggesting this is likely attributable to obesity and not to MASLD itself.
Apart from the higher risk of premature birth, outcomes for babies were generally comparable between the MASLD and non-MASLD groups.
“We did not find any increased risk in women with MASLD of having children with congenital malformations or of having children who died at birth,” said Jonas F. Ludvigsson, MD, PhD, the study’s senior author, a pediatrician at Örebro University Hospital in Sweden, and a professor at Karolinska Institutet.
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