MAFLD and Pregnancy: What are the Consequences?

Abstract

We congratulate Lee et al1Lee S.M. et al.Clin Gastroenterol Hepatol. 2022; 20: 2542-2550.e8Abstract Full Text Full Text PDF Scopus (5) Google Scholar for their study, “Metabolic dysfunction-associated fatty liver disease and subsequent development of adverse pregnancy outcomes.” In this study, the investigators divided the subjects into 3 groups: non–metabolic dysfunction-associated fatty liver disease (MAFLD), nonalcoholic fatty liver disease (NAFLD) without metabolic dysfunction, and MAFLD. Their main outcome was the impact of MAFLD on pregnancy outcomes. They found that those with MAFLD experienced a higher risk for adverse pregnancy outcomes (gestational diabetes, gestational hypertension, cesarean delivery, and preterm birth) compared with the other groups.2Dyah A.A. et al.Clin Exp Hepatol. 2021; 7: 305-311Crossref PubMed Scopus (3) Google Scholar However, we found it confusing to follow which groups were being discussed because the terminology NAFLD, hepatic steatosis, non-NAFLD MD, and MAFLD were not consistently used throughout the manuscript. In addition, the investigators did not discuss how hepatic steatosis was measured until their limitations and it was only there that they mentioned the exclusion of those with alcoholic liver disease. It is important to point out, that by definition, NAFLD is the presence of fat concentration >5%–10% of the liver weight or hepatic steatosis in >5% of the hepatocytes on biopsy after the exclusion of other liver diseases that can cause fatty liver and the significant use of alcohol.3Puri P. et al.Clin Liver Dis (Hoboken). 2012; 1: 99-103Crossref PubMed Google Scholar The study authors did not address alcohol consumption at any point and as such, their findings may be influenced by other factors not controlled for, such as alcohol use. This is an especially important point because MAFLD does not exclude alcohol consumption so it is important to know how this variable was handled in the whole study cohort. In addition, the authors argue that MAFLD may capture more pregnant patients that are at risk for adverse outcomes. However, overall, their results are not significantly different than what was recently published in a meta-analysis of adverse outcomes among pregnant women who had NAFLD.4Jamaly H. et al.Clin Mol Hepatol. 2021 Sep 17; (Epub Ahead Of Print. Pmid: 34530527)https://doi.org/10.3350/Cmh.2021.0205Crossref PubMed Google Scholar Nevertheless, we thank the authors for studying this important topic of the presence of fatty liver in women who are pregnant. As the rate of fatty liver and maternal age continue to increase, this disease state may become more prevalent requiring early intervention to preclude adverse outcomes.5Azzaroli F. et al.Expert Rev Gastroenterol Hepatol. 2020; 14: 127-135Crossref PubMed Scopus (9) Google Scholar Metabolic Dysfunction-Associated Fatty Liver Disease and Subsequent Development of Adverse Pregnancy OutcomesClinical Gastroenterology and HepatologyVol. 20Issue 11PreviewRecently, metabolic dysfunction–associated fatty liver disease (MAFLD), rather than nonalcoholic fatty liver disease (NAFLD), was proposed to better describe liver disease associated with metabolic dysfunction (MD). In this study, we attempted to investigate the impact of MAFLD on pregnancy complications. Full-Text PDF ReplyClinical Gastroenterology and HepatologyVol. 20Issue 11PreviewWe thank Dr. Nguyen for her interest in our work on the impact of metabolic dysfunction–associated fatty liver disease (MAFLD) on pregnancy complications. First, we recognize that detailed explanations were not included in the Methods section regarding study methods because of the word count limitation of Clinical Gastroenterology and Hepatology.1 Instead, we have included more detailed instructions about our study protocol in the Supplementary Methods. The participants were evaluated for hepatic steatosis by means of liver ultrasonography at 10–14 weeks of gestation as presented in the Methods section, and hepatic steatosis was defined as the presence of bright echogenic patterns in the liver parenchyma as described in the Supplementary Methods. Full-Text PDF