Women diagnosed with metabolic dysfunction–associated steatotic liver disease prior to giving birth may face a higher risk of pregnancy complications, including preterm delivery and emergency cesarean sections, according to new research from Sweden.
Investigators analyzed 240 births among 162 women with biopsy-confirmed metabolic dysfunction–associated steatotic liver disease (MASLD) and compared them with 1,140 matched births among women without liver disease. Preterm delivery (< 37 weeks) occurred in 16.7% of MASLD pregnancies vs 4.7% of comparator pregnancies. After adjusting for maternal obesity, smoking, and other factors, MASLD was associated with over three times the risk of preterm birth (adjusted odds ratio [OR] = 3.41, 95% confidence interval [CI] = 1.98–5.88).
This elevated risk was observed for both medically indicated preterm births (adjusted OR = 11.90, 95% CI = 2.46–57.59) and spontaneous preterm births (adjusted OR = 2.42, 95% CI = 1.16–5.04).
Compared with women with overweight or obesity without MASLD, the risk of preterm birth remained significantly higher among the patients in the MASLD group (adjusted OR = 4.60, 95% CI = 2.00–10.60), indicating that the association wasn't solely driven by weight-related factors.
Cesarean (C)-section rates were also higher in the MASLD group, with 32.1% of births delivered via C-section compared with 16.0% in the control group (adjusted OR = 1.63, 95% CI = 1.17–2.27), mostly as a result of emergency procedures. However, this association disappeared when the comparison was limited to women with overweight and obesity, suggesting that obesity may mediate the relationship between MASLD and C-section delivery.
The investigators didn't find clear links between MASLD and other major neonatal complications. Stillbirth rates were identical in both groups (0.4%), and there were no statistically significant differences in the rates of neonatal mortality, congenital malformations, or Apgar scores below 7 at 5 minutes.
Low birth weight (< 2,500 g) was more common among infants born to women with MASLD (adjusted OR = 2.66, 95% CI = 1.35–5.24), though this association was no longer statistically significant when restricting the analysis to full-term births.
The severity of liver diseases from steatosis to cirrhosis—didn't correlate with a higher risk of preterm birth. Most women in the cohort had mild disease, and the small number of severe cases limited further analysis.
To address potential familial confounding, the investigators compared outcomes in women with MASLD with those of their full sisters without MASLD. The increased risk of preterm birth persisted, suggesting that MASLD itself—not shared genetic or environmental factors—was likely responsible.
The investigators concluded that MASLD may independently contribute to adverse pregnancy outcomes, even in the absence of conditions like diabetes or hypertension. They noted the need for increased clinical vigilance among pregnant women with MASLD, though the study didn't call for immediate changes to clinical practice guidelines.
Full disclosures are available in the published study.
Source: eClinicalMedicine