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. 2020 Sep;73(3):516-522.
doi: 10.1016/j.jhep.2020.03.049. Epub 2020 Jun 9.

Non-alcoholic fatty liver disease in pregnancy is associated with adverse maternal and perinatal outcomes

Monika Sarkar  1 , Joshua Grab  2 , Jennifer L Dodge  2 , Erica P Gunderson  3 , Jessica Rubin  4 , Roxanna A Irani  5 , Marcelle Cedars  5 , Norah Terrault  6
Affiliations

Non-alcoholic fatty liver disease in pregnancy is associated with adverse maternal and perinatal outcomes

Monika Sarkar et al. J Hepatol. 2020 Sep.

Abstract

Background & aims: The prevalence of non-alcoholic fatty liver disease (NAFLD) is rising in young adults, with potential implications for reproductive-aged women. Whether NAFLD during pregnancy confers more serious risks for maternal or perinatal health is unclear.

Methods: Using weighted discharge data from the US national inpatient sample, we evaluated temporal trends of NAFLD in pregnancies after 20 weeks gestation, and compared outcomes to pregnancies with other chronic liver diseases (CLDs) or no CLD. Study outcomes included preterm birth, postpartum hemorrhage, hypertensive complications (pre-eclampsia, eclampsia, and/or hemolysis, elevated liver enzymes, and low platelets syndrome), and maternal or fetal death. NAFLD prevalence was estimated by calendar year and temporal trends tested by linear regression. Outcomes were analyzed by logistic regression adjusted for age, race, multiple gestation, and pre-pregnancy diabetes, obesity, dyslipidemia and hypertension.

Results: Among 18,574,225 pregnancies, 5,640 had NAFLD and 115,210 had other, non-NAFLD CLD. Pregnancies with NAFLD nearly tripled from 10.5/100,000 pregnancies in 2007 to 28.9/100,000 in 2015 (p <0.001). Compared to the other groups, patients with NAFLD during pregnancy more frequently experienced gestational diabetes (7-8% vs. 23%), hypertensive complications (4% vs. 16%), postpartum hemorrhage (3-5% vs. 6%), and preterm birth (5-7% vs. 9%), all p values ≤0.01. On adjusted analysis, compared to no CLD, NAFLD was associated with hypertensive complications, preterm birth, postpartum hemorrhage and possibly maternal (but not fetal) death.

Conclusion: The prevalence of NAFLD in pregnancy has nearly tripled in the last decade and is independently associated with hypertensive complications, postpartum hemorrhage and preterm birth. NAFLD should be considered a high-risk obstetric condition, with clinical implications for pre-conception counseling and pregnancy care.

Lay summary: The prevalence of non-alcoholic fatty liver disease (NAFLD) in pregnancy has almost tripled over the past 10 years. Having NAFLD during pregnancy increases risks for both the mother and the baby, including hypertensive complications of pregnancy, bleeding after delivery, and preterm birth. Thus, pre-conception counseling is warranted with consideration of high-risk obstetric management among women with NAFLD in pregnancy.

Keywords: Chronic liver disease; Complications; Non-alcoholic steatohepatitis; Reproductive health.

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Conflict of interest statement

Conflicts of Interest MS is the site principal investigator for a NAFLD clinical trial funded by Zydus pharmaceuticals. NT is on the advisory board at Intercept Pharmaceuticals and receives grant support Gilead Sciences. No other authors have relevant conflicts of interest. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

Figure 1.
Figure 1.
Temporal Trends in NAFLD Prevalence in Pregnancy (2007–2016). P-value < 0.001 (test of trend).
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