A liver condition that many people have never heard of may affect around one in six women of childbearing age worldwide. A 2025 global analysis estimated that 15.8% of women aged 15 to 49 were living with metabolic dysfunction-associated steatotic liver disease (MASLD) in 2021.
Imagine Lisa, 31, arriving for her first pregnancy appointment. Five years earlier, routine blood tests had shown mildly raised liver enzymes, markers that can indicate liver damage. Further tests found excess fat in her liver. Because she also has obesity and type 2 diabetes, and other possible causes have been ruled out, her findings fit the diagnostic criteria for MASLD.
MASLD is the new name for what was previously called non-alcoholic fatty liver disease, or NAFLD. It describes excess fat in the liver alongside at least one metabolic risk factor, such as type 2 diabetes, high blood pressure, obesity or abnormal levels of fats in the blood.
Now that Lisa is pregnant, she has a simple question: what does this diagnosis mean for her and her baby?
The evidence is still developing. Pregnancy-specific research and guidance on MASLD remain much less extensive than the evidence available for the condition in the wider adult population.
The issue is becoming increasingly relevant. Between 2010 and 2021, the estimated global prevalence of MASLD among women aged 15 to 49 increased by almost 14%, with prevalence rising with age within this group.
The timing is notable. In May 2026, the World Health Assembly adopted a resolution recognising steatotic liver disease, the wider group of liver conditions that includes MASLD, as a growing global health challenge. It calls for better prevention, diagnosis and integration of liver disease into strategies addressing long-term conditions such as diabetes and cardiovascular disease.
Pregnancy itself causes substantial changes in how the body handles glucose and fats, including a gradual reduction in sensitivity to insulin, the hormone that helps move glucose from the blood into cells.
Evidence suggests that women with MASLD have higher rates of several pregnancy complications. An in-depth review of 22 studies involving 13,641 women with NAFLD found higher odds of gestational diabetes, high blood pressure during pregnancy, pre-eclampsia and preterm birth, meaning birth before 37 weeks. Most of these studies used the older NAFLD terminology.
Interpreting these findings is complicated because MASLD often occurs alongside obesity and other metabolic conditions that can themselves influence pregnancy outcomes. Earlier studies were also often small or unable to examine the severity of liver disease separately.
Using nationwide Swedish healthcare data, we and our colleagues studied 240 births to 162 women with biopsy-confirmed MASLD and compared them with 1,140 matched births to women without known MASLD.
One finding stood out. Preterm birth occurred in 16.7% of pregnancies among women with MASLD, compared with 4.7% in the comparison group. After accounting for other measured factors, the odds indicated a 3.4 higher risk of preterm birth.
The association remained when women with MASLD were compared with women who were overweight or had obesity but no known MASLD, and when researchers compared pregnancies within families to reduce the influence of shared genetic and environmental factors. This strengthens the evidence that MASLD may play a role, but the study was observational and therefore cannot prove that MASLD caused the premature births.
Having more advanced MASLD, including fibrosis, which means scarring of the liver, did not appear to further increase the risk of adverse pregnancy outcomes in the Swedish study. However, the numbers of women with more severe disease were small and the statistical uncertainty was substantial.
Women with MASLD also had higher odds of caesarean delivery. But that difference was no longer clear when they were compared with women who were overweight or had obesity without known MASLD, suggesting that body weight or related factors could account for much of the association.
What about the children?
The evidence is more limited. In another Swedish nationwide study, 239 children born to mothers with biopsy-confirmed MASLD had a higher rate of serious infections requiring hospital care than 1,131 comparison children. Across follow-up, their adjusted rate was about 1.8 times higher, with the strongest association during the first year of life, when it was about three times higher. Again, this was an observational finding and does not establish that maternal MASLD caused the infections.
There is some reassuring evidence too. The same Swedish cohort has so far shown no clear evidence of increased cancer or death through early adulthood. Another study found no statistically clear increase in autoimmune diseases, conditions in which the immune system mistakenly attacks the body’s own tissues.
These apparently reassuring findings also require caution. The studies contained only 239 children exposed to maternal MASLD and relatively few cases of cancer, death or autoimmune disease, so larger studies with longer follow-up are needed.
For women like Lisa, these uncertainties affect real conversations about pregnancy, monitoring and risk. As MASLD becomes increasingly common among women of childbearing age, doctors are likely to encounter it more often in pregnancy. Better evidence is needed to tell women what the diagnosis means for them and for their children.
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