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