Metabolic-dysfunction-associated steatotic liver disease is the most common chronic liver condition globally, increasingly relevant in pregnancy due to rising maternal metabolic risks. The study explores MASLD in early pregnancy as a potential independent risk factor for hypertensive disorders of pregnancy (HDPs).

In this prospective study, we assessed MASLD in 198 pregnant women at 10–14 weeks' gestation using demographic, clinical, metabolic, and hepatic parameters measured by transient elastography. We followed participants prospectively for the development of HDPs. We used standardised protocols, blinded operators, and validated cutoff values. We used multivariable logistic regression to assess the association between MASLD and HDPs, adjusting for prespecified clinical and metabolic covariates.

MASLD was present in 48 (24.2%) women. HDPs developed in 11/48 (22.9%) women with MASLD compared with 9/150 (6.0%) without MASLD (p=0.002). In the fully adjusted model, MASLD was associated with higher odds of HDPs, although the association did not reach statistical significance (adjusted OR 2.89, 95% CI 0.90–9.54; p=0.075). In the exploratory bidirectional stepwise model, MASLD remained associated with HDPs (aOR 2.99, 95% CI 1.08–8.29; p=0.035).

MASLD was detected in 24% of women in early pregnancy. Early-pregnancy MASLD was associated with higher odds of subsequent HDPs in this cohort. Although the fully adjusted model did not demonstrate a statistically significant association, the effect estimate was approximately threefold and was similar in the exploratory stepwise model. Given the small number of HDPs events and the limitations of stepwise variable selection, these findings should be considered hypothesis-generating and require confirmation in larger prospective studies.