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Liver Int. 2016 Feb;36(2):268-74. doi: 10.1111/liv.12902. Epub 2015 Sep 9.

Adverse outcomes of pregnancy in women with non-alcoholic fatty liver disease.

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Center for Digestive Diseases, Unit of Hepatology, Karolinska University Hospital, Institute of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Institutet, Stockholm, Sweden.
Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska University Hospital and Institutet, Stockholm, Sweden.
Department of Medicine, Visby Hospital, Visby, Sweden.



Non-alcoholic fatty liver disease (NAFLD) is considered the most common liver disease in the world, but little is known about its potential association with pregnancy outcomes. We aimed to investigate pregnancy outcomes in NAFLD.


The Swedish Medical Birth Register (MBR) was used to identify births between 1992 and 2011 (N = 1 960 416). By linkage with the National Patient Register, we identified women with a diagnosis of NAFLD. The MBR was then used to identify outcomes: gestational diabetes, pre-eclampsia, Caesarean section, Apgar score <7 at 5 min, preterm birth (<37 weeks), low birth weight (<2500 g), infants born small for gestational age and congenital malformations. As controls, we used women with no diagnosis for NAFLD divided into two groups; with and without polycystic ovary syndrome (PCOS). Poisson regression was used to estimate relative risks (RRs) adjusted for maternal age, smoking status and body mass index at early pregnancy, parity and prepregnancy diabetes.


We identified 110 pregnancies in women with NAFLD. Using women without a diagnosis of NAFLD or PCOS as controls; NAFLD was associated with gestational diabetes [adjusted RRs 2.78; 95% confidence interval (CI): 1.25-6.15], pre-eclampsia (aRR 1.95; 95% CI 1.03-3.70), Caesarean section (aRR 1.52; 95% CI 1.19-1.94), preterm birth (aRR 2.50; 95% CI 1.38-4.55) and with low birth weight (aRR 2.40; 95% CI 1.21-4.78).


Women with a diagnosis of NAFLD prior to giving birth have increased risks for adverse pregnancy outcome independently of body mass index and diabetes, and should be carefully monitored during antenatal care.


Caesarean section; epidemiology; gestational diabetes; pre-eclampsia; preterm birth; small for gestational age

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