Researchers don’t know why there’s a threefold higher risk in patients with metabolic-dysfunction-associated steatotic liver disease.
Preterm birth may be three times more likely for women with metabolic-dysfunction-associated steatotic liver disease (MASLD), independent of obesity.
MSALD is often accompanied by other risk factors for adverse pregnancy outcomes, such as high BMI, gestational diabetes and hypertension. However, new research from Sweden found that birth prior to 37 weeks gestation was far more common in women with MSALD when compared to controls with high BMI and a variety of other demographic and pregnancy risk factors.
Researchers compared 240 births from women with biopsy-proven MASLD with 1140 matched non-MASLD births between 1992 and 2017. The comprehensive modelling accounted for various other factors, including gestational diabetes and hypertension, and even compared familial pregnancy outcomes using non-MASLD siblings.
Professor Amanda Henry, program head in women’s health at the George Institute for Global Health, told Gut Republic that greater histopathological severity of MASLD in the study was also not tied to an increase in adverse pregnancy outcomes.
“The suggestion that having MASLD is independently associated with preterm birth (over and above BMI status and the complications we know are more common in MASLD such as diabetes and hypertension) is a little surprising,” said the UNSW professor of obstetrics.
“Patients with MASLD do need to be recognised as a higher-risk group, including by GPs as the first point of pregnancy contact.”
She explained that given the associations with higher BMI, gestational diabetes and hypertensive pregnancy, women with MASLD are usually recognised as a risk group anyway and pregnancy care is adjusted accordingly.
“However, more explicitly recognising that women with known or suspected MASLD are a higher-risk pregnancy group and discussing this at the first visit will be helpful. Explanations to women about appropriate increased care such as early GDM screening and preeclampsia prevention measures will also enhance care for these patients,” she said.
“It is worth noting that the absolute gestation length was about one week shorter in the MASLD group and the vast majority of the preterm births were late preterm – still clinically important but reassuring that there was not a high rate of early preterm birth.”
Professor Henry also highlighted that most of the difference appeared to be in medically indicated preterm birth rather than spontaneous preterm birth, which could be due to the various medical complications associated with MASLD.
“As expected, there were higher rates of pre-pregnancy or pregnancy diabetes and hypertension in the MASLD group, although preeclampsia was not significantly increased (this may have been a power issue as the absolute rates were higher),” she said.
“There were comparable neonatal outcomes between groups.”
“MASLD was also linked to increased Caesarean rates, however not when compared to non-MASLD women of high BMI and in the adjusted models, suggesting that it is demographic factors and pregnancy complications that drive the increased Caesarean rates rather than MASLD itself.”
Professor Henry also highlighted that that the study was limited to a Scandinavian setting, which was a less ethnically diverse population than Australia.
“The biological mechanisms may become clearer in future, or it is possible that there are additional confounding effects not accounted for in the study,” she said.
