Associations of metabolic dysfunction-associated steatotic liver disease and cardiometabolic risk factor abnormalities with adverse pregnancy outcomes

Objective: To investigate the association between metabolic dysfunction-associated steatotic liver disease (MASLD) and the risk of adverse pregnancy outcomes, and to analyze the impact of the type and severity of cardiometabolic risk factor (CMRF) abnormalities on this association.

Methods: A retrospective cohort study was conducted among primiparous women with singleton pregnancies who had registered at Beijing Friendship Hospital from March 10, 2020, to December 31, 2022. A total of 2 623 women were included. Basic characteristics and delivery outcomes were documented, liver ultrasound and relevant prenatal examinations were performed, and adverse pregnancy outcomes were diagnosed. Modified Poisson regression models were used to analyze the association between MASLD and adverse pregnancy outcomes. The relationship between the type or severity of CMRF abnormalities in MASLD and the risk of adverse pregnancy outcomes was also explored.

Results: After adjusting for confounding factors including age, gestational weight gain, and education level, MASLD was associated with an increased risk of cesarean section (RR=1.531, 95%CI: 1.304-1.799, P < 0.001), gestational diabetes mellitus (GDM; RR=2.409, 95%CI: 1.948-2.979, P < 0.001), pregnancy-associated hypertension (PAH; RR=3.062, 95%CI: 2.069-4.533, P < 0.001), preterm birth (RR=2.145, 95%CI: 1.342-3.429, P=0.001), and large for gestational age (LGA; 2.224, 95%CI: 1.599-3.095, P < 0.001). However, no significant associations were found for small for gestational age or postpartum hemorrhage. After adjusting for other CMRF abnormalities, the risk of adverse pregnancy outcomes varied among MASLD pregnant women with different CMRF abnormalities: the body mass index abnormal group had higher risks of cesarean section, GDM, PAH, preterm birth, and LGA; the glucose abnormal group had an increased risk of GDM; the blood pressure abnormal group had a higher risk of PAH; the high density lipoprotein cholesterol abnormal group had higher risks of cesarean section, GDM, and PAH; and the triglyceride abnormal group was associated with higher risks of GDM and preterm birth. Additional, as the severity of CMRF abnormalities increased, the risks of cesarean section (RR=1.199, 95%CI: 1.112-1.292, P < 0.001), GDM (RR=1.478, 95%CI: 1.345-1.624, P < 0.001), PAH (RR=1.626, 95%CI: 1.367-1.934, P < 0.001), preterm birth (RR=1.384, 95%CI: 1.120-1.710, P=0.003), and LGA (RR=1.422, 95%CI: 1.224-1.650, P < 0.001) continued to rise.

Conclusions: MASLD during pregnancy is associated with an increased risk of multiple adverse pregnancy outcomes, and the type and severity of CMRF abnormalities significantly influence this association. These results suggest that attention should be paid to the specific CMRF abnormalities when diagnosed MASLD, as this may help to facilitate targeted interventions and reduce the risk of adverse pregnancy outcomes.