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. 2025 May 9:83:103238.
doi: 10.1016/j.eclinm.2025.103238. eCollection 2025 May.

Adverse pregnancy and birth outcomes in women with biopsy-proven MASLD: a nationwide cohort study

Carole A Marxer  1 , Fahim Ebrahimi  1   2 , David Bergman  1 , Jiangwei Sun  1 , Hannes Hagström  3   4 , Marcus Thuresson  1   5 , Olof Stephansson  6   7 , Jonas F Ludvigsson  1   8   9
Affiliations

Adverse pregnancy and birth outcomes in women with biopsy-proven MASLD: a nationwide cohort study

Carole A Marxer et al. EClinicalMedicine. .

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has been linked to an increased risk of adverse pregnancy outcomes. We aimed to assess the roles of obesity, familial factors, and disease severity.

Methods: Nationwide cohort study in Sweden (1992-2017) including 240 births (162 women) with biopsy-proven MASLD vs. 1140 matched reference births (1138 women). Multivariable conditional logistic regression determined adjusted odds ratios (aORs) for adverse pregnancy outcomes.

Findings: Preterm birth occurred in 40 (16.7%) births of women with MASLD compared to 53 (4.7%) in reference births, yielding an aOR of 3.41 (95% CI = 1.98-5.88), which remained increased when compared with overweight/obese women without known MASLD (aOR = 4.60, 95% CI = 2.00-10.60). The association was observed for both medically indicated preterm birth (aOR = 11.90, 95% CI = 2.46-57.59) and spontaneous preterm birth (aOR = 2.42, 95% CI = 1.16-5.04). The aOR of preterm birth did not increase with MASLD severity (MASH without fibrosis/noncirrhotic fibrosis/cirrhosis: aOR = 1.53, 95% CI = 0.23-10.02), but 95% CIs were wide. MASLD was linked to increased odds of cesarean section (aOR = 1.63, 95% CI = 1.17-2.27), but not when compared with overweight/obese reference women (aOR = 1.20, 95% CI = 0.77-1.86). Our results indicate comparable Apgar scores, and similar rates of congenital malformation, stillbirth and neonatal death in both groups. Main results were confirmed in sibling analyses (i.e., when comparing to births of full female siblings of the mothers).

Interpretation: MASLD is a risk factor for preterm birth, independent of obesity and familial factors. MASLD however does not indicate more stillbirths and neonatal deaths. We did not find more adverse pregnancy outcomes with increasing MASLD severity.

Funding: Swiss National Science Foundation (P500PM_217670, P500PM_210866), European Crohn's and Colitis Organisation and, The Swedish Society for Medical Research (PG-23-0315-H-02) and Karolinska Institute.

Keywords: Cesarean section; Epidemiology; MASLD; Pregnancy outcomes; Preterm birth.

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Conflict of interest statement

C.A.M. has no conflict of interest. F.E. has served as an advisory board member for Boehringer Ingelheim. D.B.: has no conflict of interest. J.S.: has no conflict of interest. H.H.: HH:s institutions have received research funding from Astra Zeneca, EchoSens, Gilead, Intercept, MSD, Novo Nordisk and Pfizer. H.H. has served as consultant or on advisory boards for Astra Zeneca, Bristol Myers-Squibb, MSD and Novo Nordisk and has been part of hepatic events adjudication committees for Arrowhead, Boehringer Ingelheim, KOWA and GW Pharma. All disclosures are unrelated to the study. M.T.: has no conflict of interest. O.S.: has no conflict of interest. J.F.L.: Dr Ludvigsson has coordinated an unrelated study on behalf of the Swedish IBD quality register (SWIBREG). That study received funding from Janssen corporation. Dr Ludvigsson has also received financial support from Merck developing a paper reviewing national healthcare registers in China. Dr Ludvigsson has an ongoing research collaboration on celiac disease with Takeda; and additional collaboration within IBD with Merck. All disclosures are unrelated to the study.

Figures

Fig. 1
Fig. 1
Flow chart of cohort enrolment. Abbreviations: MASLD, metabolic dysfunction-associated steatotic liver disease; MASH, metabolic dysfunction-associated steatohepatitis.
Fig. 2
Fig. 2
Forest plot of pregnancy and birth outcomes for all births in women with MASLD vs. births in reference women without known MASLD.
See this image and copyright information in PMC

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