Systematic review with meta-analysis: Non-alcoholic fatty liver disease and the association with pregnancy outcomes

Abstract

Background and Aims: Maternal and fetal outcomes in pregnant patients with NAFLD have been largely unexplored. To determine the level of evidence associated with both maternal and fetal outcomes in pregnant women with NAFLD. Method:We conducted a comprehensive literature search. The studies included pregnant patients with a previous, current or subsequent diagnosis of NAFLD. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI).Results: Twenty two studies, with 13641 female NAFLD patients were reviewed. The results highlight that NAFLD patients had a statistically significant increased likelihood of baseline Diabetes Mellitus (OR= 6.00,

Elevated Hepatic Steatosis Index is Associated with the Development of Adverse Maternal, but Not Adverse Neonatal, Outcomes: A Retrospective Cohort Study

“…Prior studies have found that MAFLD during pregnancy was associated with an increased risk of adverse neonatal outcomes, although results remain conflicting. MAFLD has been associated with a higher risk of having both SGA 5 or LGA neonates, 4 , 6 , 23 whilst pre-term birth 4 , 5 and extreme prematurity (<32 weeks) 5 have also been reported. Differences are likely secondary to the total sample size of the studies, varying predominant ethnicities of the populations examined and confounding variables able to be captured and assessed.…”

“…More recently, an Australian meta-analysis determined that MAFLD (diagnosed on imaging and/or histology) was associated with a 3-fold higher risk of GDM and pre-eclampsia, and a 2-fold higher risk of pre-term birth and large-for-gestational age (LGA) neonates. 6 …”

“…4 Of concern, MAFLD has been associated with adverse pregnancy outcomes. [4][5][6] A Swedish study found women with MAFLD had higher risks of gestational diabetes mellitus (GDM), pre-eclampsia, neonate prematurity and low birth weight. 5 A United States study additionally ascertained postpartum hemorrhage more frequently occurred in women with MAFLD compared to those without.…”

“…More recently, an Australian meta-analysis determined that MAFLD (diagnosed on imaging and/or histology) was associated with a 3-fold higher risk of GDM and pre-eclampsia, and a 2-fold higher risk of pre-term birth and large-for-gestational age (LGA) neonates. 6 Although liver biopsy remains the gold standard for diagnosing MAFLD, most of its diagnosis can be achieved through non-invasive measures. 1,2 Serum liver enzymes, particularly aspartate aminotransferase (AST) and alanine aminotransferase (ALT), have been used to form clinical indices of hepatic steatosis, 7,8 such as the Hepatic Steatosis Index (HSI).…”

MAFLD and Pregnancy: What are the Consequences?

“…However, overall, their results are not significantly different than what was recently published in a meta-analysis of adverse outcomes among pregnant women who had NAFLD. 4 Nevertheless, we thank the authors for studying this important topic of the presence of fatty liver in women who are pregnant. As the rate of fatty liver and maternal age continue to increase, this disease state may become more prevalent requiring early intervention to preclude adverse outcomes.…”