Elevated Hepatic Steatosis Index in Early Pregnancy Signals Higher Risk of Adverse Birth Outcomes

New research highlights the importance of monitoring the hepatic steatosis index (HSI) in early pregnancy as a predictive marker for adverse perinatal outcomes. Drawing on data from over 42,000 pregnant women, the study found that elevated HSI levels during the first trimester were significantly associated with increased risks of cesarean delivery, preterm birth, large-for-gestational-age (LGA) infants, and shoulder dystocia.1

The HSI, a non-invasive index calculated using liver enzyme levels and pre-pregnancy BMI, was divided into quartiles. As maternal HSI increased across these quartiles, so did the incidence of key complications. Women in the highest HSI group had 77% higher odds of cesarean delivery, 32% higher odds of preterm birth, and nearly triple the odds of delivering an LGA infant compared to those in the lowest group. The risk of shoulder dystocia also rose significantly. Notably, non-linear relationships were observed for cesarean delivery, preterm birth, and LGA, suggesting that even moderate elevations in HSI warrant attention.

Subgroup analyses revealed that the associations were particularly strong among younger women and those experiencing their first pregnancy. These findings indicate that HSI may help identify metabolic risk even in populations not typically flagged as high-risk in standard antenatal care.

The rising burden of metabolic dysfunction-associated steatotic liver disease (MASLD) among women of childbearing age adds urgency to these findings. While liver biopsy and imaging remain gold standards for diagnosing steatosis, HSI provides a practical, cost-effective alternative suitable for routine screening in pregnancy. Earlier identification of metabolic stress could support targeted interventions to reduce complications for both mother and child.

In conclusion, this study supports the incorporation of HSI into first-trimester risk assessments. By identifying women with subclinical metabolic dysfunction early, clinicians may be able to reduce the burden of adverse pregnancy outcomes and improve long-term maternal and neonatal health.

Source: Su S, Zhang E, Gao S, Zhang Y, Liu J, Xie S, Yu J, Zhao Q, Yue W, Liu R, Yin C. Associations of hepatic steatosis index in early pregnancy with pregnancy outcomes: a prospective birth cohort study. Clin Med (Lond). Epub ahead of print 2025. doi:10.1016/j.clinme.2025.100343.