Trimester‐Specific Impacts of Steatotic Liver Disease on Adverse Pregnancy Outcomes: A Retrospective Cohort Study

Background and Aims Steatotic liver disease (SLD) is increasingly identified in pregnant populations. However, its associations with adverse pregnancy outcomes (APOs) in relation to specific trimesters remain unclear. This study aimed to evaluate the trimester‐specific associations between SLD and APOs. Methods This study included 3806 pregnant women from Beijing Friendship Hospital. Hepatic ultrasonography was performed to assess SLD status during the first (T1) and third (T3) trimesters. Associations between SLD and APOs were assessed using logistic regression. Results The prevalence of SLD among pregnant women was 10.27%, varying across trimesters. Persistent SLD (present in both T1 and T3) demonstrated positive associations with overall APOs (OR = 1.728, 95% CI: 1.202–2.502, p = 0.003), including pregnancy‐associated hypertension (OR = 1.742; 95% CI: 1.019–2.916; p = 0.038), preterm birth (OR = 2.552, 95% CI: 1.019–5.965, p = 0.037), and large‐for‐gestational‐age neonates (OR = 1.762, 95% CI: 1.080–2.820, p = 0.020). T1 SLD (OR = 1.737, 95% CI: 1.128–2.700, p = 0.013) and persistent SLD (OR = 1.821, 95% CI: 1.282–2.600, p < 0.001) were both associated with a higher risk of caesarean section. Notably, T3 SLD was significantly associated with postpartum haemorrhage (OR = 2.154; 95% CI: 1.025–4.078; p = 0.028). A marginal association was observed between pregnancy‐associated hypertension and T3 SLD (OR = 2.024; 95% CI: 0.965–3.876; p = 0.045). Conclusion Persistent SLD in pregnancy is associated with an increased risk of APOs, trimester‐specific assessment of SLD may facilitate risk stratification and inform clinical management. Further studies are warranted to evaluate whether lifestyle interventions can mitigate these risks.