Metabolic dysfunction–associated steatotic liver disease (MASLD) is increasingly recognised among individuals of reproductive age, posing growing concern during pregnancy. MASLD, formerly known as nonalcoholic fatty liver disease (NAFLD), is associated with heightened risks of gestational diabetes, preeclampsia, and preterm birth. Despite these risks, routine screening during pregnancy remains absent, though individuals with type 2 diabetes or other metabolic conditions should be evaluated with liver imaging and blood tests.
Preconception counselling is key, focusing on the need to optimise metabolic health and evaluate for advanced liver fibrosis or cirrhosis, which may require specialist input and interventions such as variceal screening. During pregnancy, aspirin from 12 weeks’ gestation is recommended to reduce the risk of preeclampsia in patients with MASLD. In the absence of cirrhosis, additional monitoring is not currently necessary.
Breastfeeding, known for its metabolic benefits to both parent and infant, is encouraged in those with MASLD, with emphasis on supporting lactation. However, significant knowledge gaps remain. Long-term studies are needed to understand how MASLD impacts metabolic health in birthing parents and offspring, and whether pregnancy accelerates liver disease progression. Safety data on MASLD-specific therapies during pregnancy and lactation is also lacking.
The updated terminology of MASLD and MASH (metabolic dysfunction–associated steatohepatitis) aligns with the broader spectrum of metabolic liver disease and reflects nearly complete overlap with the older NAFLD/NASH definitions. As the incidence of MASLD in pregnancy rises, research must prioritise longitudinal studies, particularly examining the impact of diet, exercise, and breastfeeding on disease trajectory.
With reproductive health and liver disease increasingly intersecting, comprehensive strategies are essential, from preconception to postpartum, to improve outcomes for both mother and child. This evolving field presents an opportunity to refine clinical practice and better support those affected by MASLD during and after pregnancy.
Reference
Lee BP et al. Association of alcohol and incremental cardiometabolic risk factors with liver disease: a national cross-sectional study. Clin Gastroenterol Hepatol. 2025;DOI.org/10.1016/j.cgh.2025.01.003.
