Pregnancy and Metabolic-associated Fatty Liver Disease: A Clinical Update

Fouda, Sherouk; Vennikandam, Madhu; Pappachan, Joseph M; James, Cornelius Fernandez

doi:10.14218/jcth.2022.00052

Cited by 11 publications

(7 citation statements)

References 91 publications

(105 reference statements)

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“…Metabolic dysfunction–associated steatotic liver disease (MASLD) (previously known as non-alcoholic steatohepatitis; NAFLD) is currently the most frequent chronic liver disease worldwide [ 78 ] and includes a spectrum from simple steatosis to hepatocellular injury and fibrosis. The prevalence of MASLD in pregnancy has nearly tripled in the last decade and is independently associated with a higher incidence of hypertensive complications, post-partum hemorrhage, pre-eclampsia HELLP syndrome, and preterm birth [ 79 – 81 ].…”

Section: Coincidental Liver Diseasesmentioning

confidence: 99%

“…The prevalence of MASLD in pregnancy has nearly tripled in the last decade and is independently associated with a higher incidence of hypertensive complications, post-partum hemorrhage, pre-eclampsia HELLP syndrome, and preterm birth [ 79 – 81 ]. Treatment in pregnancy mainly involves nutritional measures and physical activity [ 78 ].…”

Section: Coincidental Liver Diseasesmentioning

confidence: 99%

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Liver imaging and pregnancy: what to expect when your patient is expecting

Porrello,

Cannella,

Bernuau

et al. 2024

Insights Imaging

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Liver diseases in pregnancy can be specific to gestation or only coincidental. In the latter case, the diagnosis can be difficult. Rapid diagnosis of maternal-fetal emergencies and situations requiring specialized interventions are crucial to preserve the maternal liver and guarantee materno-fetal survival. While detailed questioning of the patient and a clinical examination are highly important, imaging is often essential to reach a diagnosis of these liver diseases and lesions. Three groups of liver diseases may be observed during pregnancy: (1) diseases related to pregnancy: intrahepatic cholestasis of pregnancy, pre-eclampsia, eclampsia, hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, and acute fatty liver of pregnancy; (2) liver diseases that are more frequent during or exacerbated by pregnancy: acute herpes simplex hepatitis, Budd-Chiari syndrome, hemorrhagic hereditary telangiectasia, hepatocellular adenoma, portal vein thrombosis, and cholelithiasis; (3) coincidental conditions, including acute hepatitis, incidental focal liver lesions, metabolic dysfunction–associated steatotic liver disease, cirrhosis, hepatocellular carcinoma, liver abscesses and parasitosis, and liver transplantation. Specific knowledge of the main imaging findings is required to reach an early diagnosis, for adequate follow-up, and to avoid adverse consequences in both the mother and the fetus.Critical relevance statement Pregnancy-related liver diseases are the most important cause of liver dysfunction in pregnant patients and, in pregnancy, even common liver conditions can have an unexpected turn. Fear of radiations should never delay necessary imaging studies in pregnancy.Key points• Pregnancy-related liver diseases are the most frequent cause of liver dysfunction during gestation.• Fear of radiation should never delay necessary imaging studies.• Liver imaging is important to assess liver emergencies and for the diagnosis and follow-up of any other liver diseases.• Common liver conditions and lesions may take an unexpected turn during pregnancy.• Pregnancy-specific diseases such as pre-eclampsia and HELLP syndrome must be rapidly identified. However, imaging should never delay delivery when it is considered to be urgent for maternal-fetal survival. Graphical Abstract

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Section: Coincidental Liver Diseasesmentioning

confidence: 99%

Section: Coincidental Liver Diseasesmentioning

confidence: 99%

Liver imaging and pregnancy: what to expect when your patient is expecting

Porrello,

Cannella,

Bernuau

et al. 2024

Insights Imaging

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“…Lasting effects on the prevalence of metabolic diseases in the next generation are exerted by maternal obesity or overnutrition during pregnancy or lactation. These include non-alcoholic fatty liver disease (also called metabolicassociated fatty liver disease), non-alcoholic steatohepatitis, obesity, diabetes, chronic kidney disease, hypertension, and cardiovascular disease [21,[64][65][66][67][68][69][70]. Peng demonstrated that offspring born to mothers who had consumed high fat diets displayed a disruption of lipid homeostasis, which was accompanied by altered methionine and abnormal one-carbon metabolism in the livers of offspring [71].…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

Parental Obesity: The Pandemic of Intergenerational Physical and Mental Health Carnage

Myers-Morrison¹

2023

IJIPEM

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A review of the maternal and paternal impact of obesity at conception on the subsequent health of the offspring paints a nightmarish future in terms of suffering and out-of-control healthcare spending. Consequences of parental obesity on the offspring include obesity, type 2 diabetes, cardiovascular disease, chronic kidney disease, stroke, and premature death. Children of obese women tend to have high blood pressure, left ventricular thickening, increased abdominal fat mass, hyperlipidemia with reduced high-density lipoprotein levels, increased aortic root diameter, insulin resistance, and elevated inflammatory markers, which culminate in a threefold greater risk of cardiometabolic complications than in children of normal-weight mothers. Babies are at greater risk of developing asthma, autism spectrum disorder, attention deficit hyperactivity disorder, cognitive delays, inflammation, cerebral palsy, epilepsy, and the chronic diseases of obesity (such as insulin resistance, high blood pressure, atherosclerosis, cardiovascular disease, stroke, some cancers, including breast, endometrial, and colon cancer, gall bladder disease, polycystic ovarian syndrome, musculoskeletal problems such as osteoarthritis and back pain, gout, cataracts, stress incontinence, and sleep apnea), as well as psychiatric disorders including substance abuse. All parents desire healthy babies, as does society, to avoid the health costs and consequences of our obesity pandemic, but significant personal, societal, public policy, economic, and marketplace interventions will be necessary to avert further devastating impacts. We need to publicize the intergenerational harm caused by obesity, offer support to individuals to help change eating habits and produce a healthier food chain for the nation. Interventions fashioned after the twelve-step program of Alcoholics Anonymous and the adoption of a low carbohydrate abstinence model have proven effective. The time has come to spread the research findings concerning obesity and intergenerational obesity. that are long-accepted by the scientific community but still not recognized by the public at large so that another generation is not impacted by lifestyles that have continuously worsened since the 1970s.

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“…Studies have reported an accumulation of liver cholesterol and triacylglycerides (TAGs) during the gestational period, as a mechanism involved in the regulation of proper fetal development in cases of maternal malnourished conditions [ 2 , 5 ]. Additionally, in response to overfeeding with high-fat diets, and obesity there is an increase of FFA acid uptake by the liver, as well as an increased lipogenesis and a decreased FA oxidation, leading to ectopic triglyceride deposition in the liver [ 6 ]. Notwithstanding, the understanding of liver lipid metabolism during pregnancy remains incomplete.…”

Section: Introductionmentioning

confidence: 99%

Hepatocyte ballooning and steatosis in early and late gestation without liver malfunction: Effects of low protein/high carbohydrate diet

Navarro-Meza,

Díaz-Muñoz,

Cruz-Ramos

et al. 2024

PLoS ONE

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Pregnancy is a challenging metabolic and physiological condition. The aim of this study was to include a second demanding situation as a low protein/high carbohydrate diet (LPHCD) to characterize the histological and functional responses of the maternal liver. It is unknown how the maternal liver responds during early and late pregnancy to LPHCD intake. We explored early pregnancy (3 and 8 gestational age, G) and late pregnancy (15 and 20 G). The results indicated that pregnant rats under control diet showed an evident presence of ballooned hepatocytes, lipid vesicles and edema at late pregnancy (15G); in contrast, pregnant rats under LPHCD showed similar pattern of histological modification but at early pregnancy (3G). Unexpectedly, the serum biomarkers didn’t display functional alterations in either group, despite of the evident histological changes no liver malfunction was detected. We conclude that pregnant rats fed with control diet and experimental LPHCD, are subjected to metabolic and physiological conditions that impact the histopathological condition of the maternal liver. Control diet promoted the histological modifications during late pregnancy whereas LPCHCD advanced the onset of these changes. Further experiments are needed to explore the biochemical mechanisms that underlie these histological modifications. Our results are also an example of the resilience associated with the pregnancy: since no functional hepatic alterations accompanied the histopathological changes, another conclusion is that no evident pathological condition was detected in this nutritional protocol.

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Pregnancy and Metabolic-associated Fatty Liver Disease: A Clinical Update

Cited by 11 publications

References 91 publications

Liver imaging and pregnancy: what to expect when your patient is expecting

Liver imaging and pregnancy: what to expect when your patient is expecting

Parental Obesity: The Pandemic of Intergenerational Physical and Mental Health Carnage

Hepatocyte ballooning and steatosis in early and late gestation without liver malfunction: Effects of low protein/high carbohydrate diet

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