MASLD in Pregnancy: Global Prevalence and Pregnancy Outcomes

MASLD in pregnancy overview

The Conversation reports on metabolic dysfunction associated steatotic liver disease MASLD, the renamed form of NAFLD, and its relevance to pregnancy. It highlights global prevalence among women of reproductive age, evolving guidance, and a Swedish birth cohort showing higher risks in MASLD pregnancies, while noting uncertainties and the need for more research.

• MASLD affects roughly 15.8% of women aged 15 to 49 in 2021
• Pregnancy risks such as gestational diabetes and preeclampsia appear elevated in MASLD pregnancies
• Swedish data show preterm birth at 16.7% vs 4.7% in controls with an adjusted odds ratio around 3.4
• Evidence on offspring infections is mixed and cancer or autoimmune signals are not clearly increased

Overview and definitions

MASLD stands for metabolic dysfunction associated steatotic liver disease and represents the rebranded category that includes excess liver fat plus at least one metabolic risk factor. A global analysis estimated that MASLD affected about 15.8% of women aged 15 to 49 in 2021. MASLD was previously termed non alcoholic fatty liver disease NAFLD. The condition is increasingly common among women of childbearing age as age-related prevalence rises and metabolic risks accumulate. In May 2026 the World Health Assembly adopted a resolution recognising steatotic liver disease as a growing global health challenge and calling for better prevention, diagnosis and integration of liver disease into strategies addressing long term conditions such as diabetes and cardiovascular disease.

Pregnancy physiology and MASLD

Pregnancy itself induces substantial metabolic changes in how the body handles glucose and fats, including reduced insulin sensitivity. When MASLD is present, these changes may interact with existing metabolic risk factors, potentially affecting pregnancy outcomes. Across studies, MASLD has been associated with higher odds of gestational diabetes, hypertension or pre eclampsia, and preterm birth. However, most studies used the older NAFLD terminology and many confounders such as obesity and other metabolic conditions complicate interpretation. The Swedish cohort analysis adds to this by showing an association that persists even after accounting for measured factors, suggesting MASLD may contribute to adverse outcomes beyond weight alone.

Global prevalence and health system context

Between 2010 and 2021 the global prevalence of MASLD among women aged 15 to 49 increased by almost 14%, with prevalence rising with age within this group. The MASLD figure of 15.8% in 2021 underscores MASLD as a common condition in reproductive-age women, increasing the likelihood that clinicians will encounter MASLD in pregnancy care. The 79th World Health Assembly resolution stresses prevention and integration of liver disease with chronic disease strategies including diabetes and cardiovascular disease, signaling that MASLD in pregnancy is likely to attract more clinical guidance and monitoring outside hepatology alone.

Pregnancy outcomes in MASLD

In a comprehensive review of 22 studies involving 13,641 women with NAFLD, MASLD-associated pregnancies showed higher odds of gestational diabetes, higher blood pressure during pregnancy, pre eclampsia and preterm birth. Many of these studies used NAFLD terminology, and the presence of obesity and other metabolic conditions complicates attribution of risk specifically to MASLD. Nevertheless, the consistency of associations across multiple analyses points toward a real signal that MASLD may contribute to adverse pregnancy outcomes through metabolic dysregulation.

Swedish findings and study design

Using nationwide Swedish health care data, researchers studied 240 births to 162 women with biopsy confirmed MASLD and compared them with 1,140 matched births to women without known MASLD. The key finding was preterm birth in 16.7% of MASLD pregnancies vs 4.7% in the comparison group, with an adjusted odds ratio of 3.4 after accounting for other measured factors. The association endured when MASLD pregnancies were compared with overweight or obese pregnancies without MASLD, and when within family analyses were used to reduce genetic and environmental confounding. While this strengthens the case for MASLD involvement, the observational design cannot establish causation and the possibility of residual confounding remains. Advanced MASLD including fibrosis did not appear to further increase risk, though small numbers limited precision, and the cesarean delivery difference largely disappeared when compared with overweight or obesity alone, suggesting body weight factors may account for much of the association.

What about children and longer term outcomes

A separate Swedish nationwide study found that children born to MASLD-affected mothers had a higher rate of serious infections requiring hospital care, with the adjusted rate about 1.8 times higher overall and around three times higher in the first year of life. However, this is based on a small number of exposures and is still observational. On the other hand, the same cohort has so far shown no clear evidence of increased cancer or death through early adulthood, and another study found no statistically clear increase in autoimmune diseases. These reassuring signals require caution because sample sizes were small and longer follow-up is needed to understand potential late effects.

Clinical implications and knowledge gaps

As MASLD becomes more common among women of childbearing age, clinicians will encounter it more frequently in pregnancy. The uncertainties surrounding monitoring, risk communication and management highlight the need for larger, longer-term studies that examine biopsy confirmed MASLD across different severities and in diverse populations. Improved guidance on pregnancy surveillance and infant outcomes will depend on assembling robust data linking MASLD status to maternal and child health over time.

Bottom line

MASLD represents an increasingly common liver metabolic disorder among women of childbearing age with potential implications for pregnancy outcomes. While Swedish data provide compelling evidence of higher preterm birth risk associated with MASLD, observational design and small sample sizes require cautious interpretation. The broader literature suggests MASLD may contribute to adverse pregnancy outcomes in the context of obesity and metabolic syndrome, but definitive causal links await further research. The evolving global recognition of MASLD through WHO and other health bodies underscores the importance of integrating liver disease awareness into reproductive health strategies and long-term disease prevention.