Non-alcoholic Fatty Liver Disease in Pregnancy: Clinical Implications, Adverse Outcomes, and Therapeutic Considerations.

BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a progressive condition characterized by excess hepatic fat accumulation in the absence of significant hepatocellular injury. Its more severe form, metabolic dysfunction-associated steatohepatitis (MASH), includes hepatic inflammation and hepatocellular ballooning and may progress to fibrosis or cirrhosis. Although MASLD appears to be slightly less prevalent in pregnant individuals than in the general population, emerging evidence suggests clinically meaningful associations with adverse maternal and neonatal outcomes. This review aims to summarize current evidence on the epidemiology, clinical implications, and management of MASLD during pregnancy. METHODS: A narrative review of the published literature was conducted to evaluate data on MASLD and MASH in pregnancy, including associations with maternal metabolic conditions, obstetric and neonatal outcomes, disease severity, screening considerations, and available therapeutic approaches. RESULTS: MASLD during pregnancy has been associated with an increased risk of adverse maternal and neonatal outcomes and demonstrates a bidirectional relationship with gestational diabetes mellitus. Several studies suggest a dose-response relationship, with greater MASLD severity corresponding to higher risks of complications. Despite these associations, routine screening for MASLD in pregnant populations is not currently recommended. Management remains centered on lifestyle interventions, including dietary modification and physical activity. Recently approved pharmacologic agents for MASH, such as resmetirom and semaglutide, represent important advances in non-pregnant populations; however, pregnancy-specific safety data for these therapies are lacking. CONCLUSIONS: MASLD in pregnancy is an emerging clinical concern with important implications for maternal and fetal health. While lifestyle modification remains the cornerstone of management, the absence of pregnancy-specific safety data for newer pharmacologic therapies highlights a critical knowledge gap. Further research is urgently needed to clarify risk stratification, screening strategies, and safe therapeutic options for MASLD in pregnant populations.