New research reveals that pregnant women with metabolic dysfunction-associated steatotic liver disease face over three times the risk of delivering prematurely compared to those without liver disease.
At a Glance
- The prevalence of fatty liver disease in pregnant women has nearly tripled over the past decade
- Women with MASLD (formerly NAFLD) have a 9% rate of preterm birth compared to 5-7% in the general population
- This increased risk persists even when compared to overweight or obese women without liver disease
- MASLD is increasingly affecting women of childbearing age and is associated with a three-fold increase in hypertensive complications
- Medical experts suggest MASLD should be considered a high-risk obstetric condition requiring specialized pregnancy care
Rising Prevalence and Serious Implications
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), has emerged as a significant health concern for pregnant women. The prevalence of this condition during pregnancy has increased dramatically, rising from 10.5 per 100,000 pregnancies in 2007 to 28.9 per 100,000 in 2015. This near-tripling of cases coincides with increasing rates of obesity and metabolic disorders in women of reproductive age, creating a concerning trend for maternal and infant health outcomes across the population.
Medical research has identified MASLD as the most common cause of liver dysfunction during pregnancy. Women with this condition face substantially higher risks of complications, including gestational diabetes, hypertensive disorders, and postpartum hemorrhage. Most concerning, however, is the significantly elevated risk of preterm birth, which can lead to numerous short and long-term health challenges for the newborn. These complications occur independent of other risk factors, suggesting that the liver dysfunction itself plays a crucial role in pregnancy outcomes.
Understanding the Preterm Birth Connection
Recent studies have quantified the relationship between MASLD and preterm birth risk. Women with this liver condition experience preterm birth at a rate of approximately 9%, compared to 5-7% in the general population. More striking is the finding that these women were over three times more likely to deliver prematurely than those without liver disease. This elevated risk remains significant even after adjusting for factors such as age, race, multiple gestation, and pre-existing conditions including diabetes, obesity, dyslipidemia, and hypertension.
The mechanism behind this connection appears complex and multifaceted. Abnormal levels of liver enzymes including AST, GGT, and total bilirubin have been identified as independent risk factors for preterm birth. These markers of liver dysfunction may signal underlying inflammatory processes that affect placental function and uterine blood flow. The study findings emphasize the importance of monitoring liver function tests in pregnant women to better predict and manage the risk of preterm birth, especially in those with known metabolic disorders.
Clinical Implications and Recommendations
Healthcare providers are beginning to recognize MASLD as a high-risk obstetric condition that warrants specialized care. Pregnant women with this condition should receive enhanced prenatal surveillance and potentially different management approaches. Researchers suggest that pre-conception counseling may be beneficial for women with MASLD, allowing for optimization of metabolic health before pregnancy begins. Some studies have even proposed investigating prophylactic measures such as low-dose aspirin to help mitigate risks in this population.
Beyond the increased preterm birth risk, women with MASLD have a 63% higher chance of requiring cesarean delivery, primarily due to higher BMI and associated complications. This further underscores the need for specialized care protocols. Medical guidelines may need updating to reflect these emerging risks, and healthcare providers should consider screening for liver dysfunction in pregnant women with metabolic risk factors. Early identification and management could potentially reduce adverse outcomes and improve both maternal and infant health in this growing at-risk population.
