The Science of SLD and Dysmetabolism-Antenatal MASH and Obesity – The Role of Maternal Health for the Next Generation

Antenatal MASH and Obesity – The Role of Maternal Health for the Next Generation

Video Transcription

Video Summary

A hepatologist presents a case of a 35-year-old woman at 18 weeks’ gestation with obesity, PCOS, and autoimmune thyroid disease who had elevated liver enzymes and positive autoimmune markers. Liver biopsy was performed to distinguish autoimmune hepatitis from other causes and revealed MASH with bridging fibrosis, underscoring that advanced MASLD/MASH often predates pregnancy. The talk reviews rising MASLD prevalence from adolescence into young adulthood and notes rapid growth of MASLD- and cirrhosis-affected pregnancies, with MASLD now a leading cause. Because pregnancy normally increases insulin resistance and triglycerides, MASLD heightens maternal risks—especially gestational diabetes, hypertensive disorders/preeclampsia, and postpartum hemorrhage—plus higher rates of intrahepatic cholestasis and acute fatty liver. Neonatal risks include prematurity and large-for-gestational-age birth; long-term child outcomes remain poorly studied. Management emphasizes preconception metabolic optimization, careful gestational weight-gain counseling, fibrosis assessment, maternal–fetal medicine co-management, and routine low-dose aspirin from 12 weeks. Medication guidance: stop resmetirom preconception; avoid GLP-1 agonists in pregnancy, consider postpartum; vitamin E is generally continued; breastfeeding is encouraged for maternal and child metabolic benefits.

Keywords

MASLD/MASH in pregnancy

metabolic dysfunction–associated steatotic liver disease

maternal risks (gestational diabetes, preeclampsia, postpartum hemorrhage)

fibrosis assessment and preconception metabolic optimization

medication management (resmetirom, GLP-1 agonists, vitamin E)