Neither Metabolic Dysfunction Associated Steatotic Liver Disease Presence Nor Fibrosis Severity, By FIB4, Predicts Adverse Pregnancy Outcomes.

BACKGROUND

Metabolic dysfunction associated steatotic liver disease (MASLD) has been associated with adverse pregnancy outcomes. Data are limited with regard to whether this association is solely related to MASLD versus comorbid metabolic conditions. This study aims to evaluate the independent contribution of MASLD to maternal and fetal outcomes.

METHODS

This single center retrospective study included adult pregnant patients who received care between 2000 and 2021. Patients with MASLD before pregnancy were age-matched with controls without chronic liver disease. Baseline FIB-4 score, within 2 years before conception, was considered a surrogate of prepregnancy MASLD severity, as an elevated FIB-4 score suggests a high risk of advanced fibrosis. Outcomes of interest included gestational age, birthweight, pre-eclampsia, 5-minute APGAR scores, gestational diabetes, and gestational hypertension. Multivariable regression was used to study the impact of MASLD and fibrosis severity on pregnancy outcomes.

RESULTS

We identified 117 pregnant women with pre-existing MASLD and 168 controls. Patients with MASLD (cases) had more underlying comorbidities than controls, including type 2 diabetes mellitus (27.4% vs. 10.1%, P<0.001), hypertension (23.9% vs. 10.7%, P=0.005), obesity (55.6% vs. 30.4% P<0.001), and metabolic syndrome (17.1% vs 4.8%, P=0.001). No differences were observed in adverse maternal or fetal outcomes between cases and controls. Among cases, no association was observed between FIB4 and adverse maternal and fetal outcomes in multivariate regression analysis.

CONCLUSIONS

Neither MASLD nor fibrosis severity, by FIB-4 score, independently influences maternal and fetal outcomes. The adverse outcomes likely reflect extrahepatic components of metabolic syndrome.