In the last decade, NAFLD in pregnancy has nearly tripled in concert with the worldwide increase in diabetes. Mayo Clinic reports that NAFLD in general affects one-fourth of the population in the United States.
According to an article in Healio, CG&H published a report that early screening for NAFLD identified 14% of pregnant women with the disease. The highest rate of NAFLD (20%) was found in Hispanic women who had a BMI of 30 or more.
Another study was conducted by Dr. Tatyana Kushner and colleagues at Mount Sinai’s medical school investigating clinical manifestations and predictors of NAFLD in pregnant women.
About the Kushner Study
Obstetric sonographers performed a liver ultrasound on a total of 540 pregnant women beginning in December 2020 through January 2021 during their normal fetal anatomy exam. The images were delivered to a radiologist for grading of steatosis, with 78 participants showing evidence of the disease.
Other results showed participants with steatosis were more likely to be Mexican or Hispanic rather than Black or African.
Dr. Kushner noted the huge implications for approximately 500,000 pregnant women in the United States with NAFLD.
NAFLD can lead to cirrhosis and liver cancer. The disease is the primary cause of liver transplantation in women and one of the leading causes of cirrhosis during pregnancy.
Emerging reports from the United States and Asia point to the relationship between NAFLD in pregnancy and adverse outcomes. Examples given were gestational diabetes and various hypertensive disorders in pregnancy.
Nonalcoholic fatty liver disease refers to various liver conditions that affect people who consume a minimal amount of alcohol. The primary characteristic of NAFLD is excessive fat that has accumulated in the cells of the liver.
Note that continuous abnormalities in the liver from nonalcoholic fatty liver (NAFL) or nonalcoholic steatohepatitis (NASH) can cause liver cancer or cirrhosis (scarring).
About NASH and Cirrhosis
NASH is a form of NAFLD where in addition to fat stored in the liver, there is also liver damage and inflammation. These symptoms can cause scarring or fibrosis in the liver. If scarring occurs, the damage may be permanent. Cirrhosis may lead to cancer.
Some people with NAFLD may develop nonalcoholic steatohepatitis (NASH) which is an aggressive type of fatty liver disease. It is marked by inflammation of the liver, and it may result in advanced cirrhosis and liver failure. The damage can be compared to injury resulting from heavy use of alcohol.
Symptoms of NASH and cirrhosis may include:
- Enlarged blood vessels beneath the surface of the skin
- Abdominal swelling
- Red palms
- Enlarged spleen
In conclusion, Dr. Kushner noted the need for additional research to better understand how NAFLD affects maternal health as well as fetal health. Interventions are needed to treat NAFLD not only in the pregnancy period but also in the postpartum period.
The doctor further states that proper care during pregnancy for women who have NAFLD requires counseling on normal weight and also on gestational weight. NAFLD should be categorized as an obstetric condition that is high-risk and has clinical implications applicable to pre-conception counseling and especially pregnancy care.