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Metabolic dysfunction-associated fatty liver disease as a risk factor for adverse outcomes in subsequent pregnancy: a nationwide cohort study

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Abstract

Background and purpose

A recent international expert consensus opinion suggested that metabolic dysfunction-associated fatty liver disease (MAFLD) replaces nonalcoholic fatty liver disease (NAFLD), since MAFLD is a better predictor of cardiovascular disease. We estimated the prevalence of FLD in fertile females and evaluated the clinical impact of either NAFLD or MAFLD on maternal and fetal outcomes during subsequent pregnancy.

Methods

The study population included fertile females who underwent health examinations and became pregnant within 1 year of health examination. Hepatic steatosis was defined as a fatty liver index of ≥ 30. The fertile females were divided into four groups: neither-FLD, NAFLD-only, MAFLD-only, and both-FLDs. During subsequent pregnancy, the risks of adverse pregnancy outcomes, including gestational diabetes, pregnancy-associated hypertension, preterm birth, and low birthweight, were compared among the four groups.

Results

The study population comprised 762,401 females, including 720,606 with neither-FLD, 318 with NAFLD-only, 14,371 with MAFLD-only, and 27,106 with both-FLDs. Compared to females with neither-FLD, the risk of adverse pregnancy outcomes was higher in females with any FLD, with an adjusted OR of 1.73 (95% CI 1.25–2.41) in the NALFD-only group, 2.65 (2.53–2.77) in the MAFLD-only group, and 2.39 (2.31–2.48) in the both-FLDs group. Pregnancy outcomes (cesarean delivery, gestational diabetes, and low birthweight) were worse in females with MAFLD compared with NAFLD.

Conclusion

Any form of FLD is a risk factor for adverse pregnancy outcomes. These data suggest that MAFLD is associated with a higher risk of adverse pregnancy outcomes for both mother and fetus than NAFLD.

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Data availability

The dataset was obtained from the National Health Insurance Service. Data cannot be shared publicly due to the violation of patient privacy and the absence of informed consent for data sharing.

Abbreviations

BMI:

Body mass index

GDM:

Gestational diabetes mellitus

GGT:

Gamma-glutamyl transferase

HDL:

High-density lipoprotein

MD:

Metabolic dysfunction

MAFLD:

MD-associated fatty liver disease

NAFLD:

Nonalcoholic fatty liver disease

TG:

Triglycerides

WC:

Waist circumference

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Funding

This work was supported by the Seoul National University Hospital research fund (0320212200), a National Research Foundation of Korea grant funded by the Korean government (MEST) (2021R1A2C2005820, 2021M3A9E4021818, 2021R1F1A1046707). This work was also supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI19C0502).

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Author notes

  1. Seung Mi Lee and Geum Joon Cho have contributed equally to this work and serve as co-first authors.

  2. Won Kim and Joong Shin Park have contributed equally to this work and serve as co-corresponding authors.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea

    Seung Mi Lee, Jeesun Lee, Young Mi Jung, Chan-Wook Park, Jong Kwan Jun & Joong Shin Park

  2. Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea

    Geum Joon Cho, Won Young Wi & Min-Jeong Oh

  3. Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA

    Errol R. Norwitz

  4. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

    Bo Kyung Koo, Soo Heon Kwak, Sae Kyung Joo & Won Kim

  5. Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea

    Bo Kyung Koo, Sae Kyung Joo & Won Kim

  6. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Korea

    Won Kim

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  1. Seung Mi Lee
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Contributions

SML, GJC, WK, and JSP designed the research; SML, GJC, BKK, WWY, JL, YMJ, SHK, ERN, CWP, JKJ, SKJ, MJO, WK, and JSP conducted the research; SML, GJC, WWY, and WK analyzed the data; SML, GJC, WK, and JSP wrote the manuscript; SML, GJC, BKK, WWY, JL, YMJ, SHK, ERN, CWP, JKJ, SKJ, MJO, WK, and JSP revised the manuscript; WK and JSP had access to all the data and had primary responsibility for the final content.

Corresponding authors

Correspondence to Won Kim or Joong Shin Park.

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Competing interest

The authors have no conflicts of interest to disclose.

Ethical approval

The study protocol was approved by the Institutional Review Board of Korea University Medical Center (2022GR0142).

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Lee, S.M., Cho, G.J., Wi, W.Y. et al. Metabolic dysfunction-associated fatty liver disease as a risk factor for adverse outcomes in subsequent pregnancy: a nationwide cohort study. Hepatol Int 17, 367–376 (2023). https://doi.org/10.1007/s12072-022-10458-w

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