PURPOSE A recent international consensus introduced revised nomenclature for steatotic liver disease (SLD). This study evaluated the impact of SLD subtypes on adverse pregnancy outcomes (apos) using updated criteria.

METHODS In this nationwide, population-based study, we analyzed 290,527 female who underwent health check-ups within 1 year before pregnancy and delivered singleton infants. Participants were categorized into non-SLD, metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD) groups.

RESULTS A total of 290,527 female were analyzed. Compared to female without SLD, those with MASLD (adjusted odds ratio [aOR] 2.44, 95% CI 2.33-2.55), MetALD (aOR 2.45, 95% CI 2.26-2.66) and ALD (aOR 2.28, 95% CI 2.11-2.47) had significantly higher risks of apos. These associations were observed for gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and preterm birth. Both MASLD and ALD were associated with increased risk of low birthweight (aOR 1.15, 95% CI 1.05-1.27 and aOR 1.21, 95% CI 1.02-1.43, respectively), whereas MetALD was not (aOR 0.96, 95% CI 0.79-1.18). Due to the low incidence of placental abruption across all groups (0.3-0.5%), associations with this outcome remained inconclusive. Additionally, a higher number of cardiometabolic risk factors (CMRFs) was associated with an increased risk of apos (p for trend of odds < 0.0001).

CONCLUSION MASLD, MetALD, and ALD were independently associated with increased risks of apos, with risk further amplified by a greater number of CMRFs. These findings underscore the importance of enhanced prenatal management for female with pre-existing SLD, particularly those with multiple CMRFs, to mitigate the risk of apos.