Effects of steatotic liver disease and cardiometabolic risk factors in MASLD on adverse pregnancy outcomes

Aim: A new definition of metabolic dysfunction-associated steatotic liver disease (MASLD) was proposed in 2023; however, its impact on adverse pregnancy outcomes (APOs) remains undetermined. This study aimed to comprehensively analyze the association between MASLD and the risk of APOs, and to evaluate the relative contributions of its components - steatotic liver disease (SLD) and cardiometabolic risk factors (CMRF). Methods: This retrospective cohort study enrolled 4,118 pregnant women admitted to the hospital between March 2020 and December 2022. Participants were categorized into MASLD and non-MASLD groups based on MASLD status. The non-MASLD group was further divided into three subgroups according to the presence of SLD and CMRF. Adjusted relative risks (aRRs) for APOs were estimated using modified Poisson regression analysis, adjusting for relevant covariates. Results: The prevalence of MASLD among pregnant women was 7.3%. MASLD was associated with elevated risks of cesarean section (aRR = 1.459, 95%CI: 1.253-1.700, P < 0.001), gestational diabetes mellitus(aRR = 2.081, 95%CI: 1.711-2.530, P < 0.001), pregnancy-associated hypertension (aRR = 2.192, 95%CI: 1.541-3.118, P < 0.001), preterm birth (aRR = 1.826, 95%CI: 1.181-2.823, P = 0.001), and large-for gestational-age neonates (aRR = 2.024, 95%CI: 1.488-2.754, P < 0.001). Compared with the CMRF-only group, the MASLD group showed higher risks of cesarean section (aRR = 1.387, 95%CI: 1.177-1.634, P < 0.001), gestational diabetes mellitus (aRR = 1.734, 95%CI: 1.405-2.139, P < 0.001), pregnancy-associated hypertension (aRR = 1.606, 95%CI: 1.105-2.333, P = 0.013), and large-for-gestational-age neonates (aRR = 1.845, 95%CI: 1.318-2.581, P = 0.001). No significant differences in risk were observed between the MASLD and SLD-only groups. Conclusion: MASLD during pregnancy is associated with an increased risk of several APOs, with SLD appearing to play a more critical role than CMRF.