MASLD Increases Preterm Birth Risk Threefold
MASLD during pregnancy raises the risk of preterm birth over threefold, independent of maternal BMI.
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Pregnant women with metabolic dysfunction-associated steatotic liver disease (MASLD) face a more than threefold increased risk of preterm birth, according to a new population-based study conducted by researchers at Karolinska Institutet. The findings, published in eClinicalMedicine, indicate that this increased risk is not solely attributable to high body mass index (BMI), a common coexisting condition in this patient population.
Preterm birth
Birth that occurs before 37 completed weeks of gestation. It is a leading cause of neonatal morbidity and mortality worldwide.
BMI (body mass index)
A measure of body fat based on height and weight. High BMI is classified as overweight or obese and is a known risk factor for pregnancy complications.
Rising prevalence of liver disease in reproductive-age women
Previously known as non-alcoholic fatty liver disease, MASLD is a chronic condition associated with metabolic disorders, including type 2 diabetes and overweight or obesity. It is estimated to affect around 20% of people in Sweden, and possibly up to 30% globally. The prevalence of MASLD is increasing, including among women of childbearing age, prompting concern about its implications for maternal and neonatal health.
Population-level data shows heightened risk
To explore this association, the researchers analyzed Swedish registry data comprising 240 births from women with MASLD and 1140 matched controls from the general population. Women with MASLD had more than three times the odds of delivering prematurely, a finding that remained consistent even when compared to women with high BMI but without diagnosed MASLD.
The increased risk of preterm birth did not vary with the severity of MASLD, suggesting that the liver condition itself may play a direct role in adverse pregnancy outcomes.
Cesarean section risk tied to BMI, not liver disease
While women with MASLD were also found to have a 63% higher likelihood of delivering by cesarean section compared to the general population, this association disappeared when compared against overweight or obese women without MASLD. The authors suggest that high BMI may be the driving factor behind the increased cesarean rate, rather than the liver disease.
No increased risk of congenital malformations
The study found no evidence of elevated risk for congenital anomalies or neonatal mortality among infants born to women with MASLD. However, the researchers caution that despite adjusting for a wide range of potential confounders and using detailed maternal BMI data, unmeasured variables could still influence the observed associations.
Congenital malformations
Structural or functional anomalies that occur during intrauterine life and can be identified prenatally, at birth or later in life.Implications for clinical guidelines
Given these findings, the authors suggest that clinical management guidelines for MASLD may need to include specific recommendations for pregnant individuals. Close monitoring throughout pregnancy could help mitigate the risk of complications in this vulnerable group.
Reference: Marxer CA, Ebrahimi F, Bergman D, et al. Adverse pregnancy and birth outcomes in women with biopsy-proven MASLD: a nationwide cohort study. eClinicalMedicine. doi: 10.1016/j.eclinm.2025.103238
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