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Although routine screening for MASLD has not been established in pregnancy, individuals with metabolic comorbidities, such as type 2 diabetes mellitus, should be evaluated by liver imaging and liver panel. Preconception counseling should address potential risks as well as need for optimized metabolic health before and during pregnancy. Fibrosis assessment should ideally be completed before pregnancy, to identify cases of cirrhosis that may warrant additional preconception management, such as variceal screening, as well as comanagement with maternal-fetal medicine specialists. In patients with MASLD, aspirin is advised at 12 weeks of gestational age to lower preeclampsia risk. In the absence of cirrhosis, no additional blood test monitoring is needed. In the general population, breastfeeding has beneficial effects on metabolic health in birthing parents and offspring and thus should be encouraged in the setting of MASLD, including access to enhanced lactation support. Research needs include evaluation of the long-term risks of MASLD in pregnancy on metabolic health in birthing parents and infants, as well as safety data for MASLD-directed therapies during pregnancy and lactation.<\/jats:p>","DOI":"10.1172\/jci186426","type":"journal-article","created":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T14:00:41Z","timestamp":1747231241000},"source":"Crossref","is-referenced-by-count":28,"title":["Metabolic dysfunction\u2013associated steatotic liver disease and pregnancy"],"prefix":"10.1172","volume":"135","author":[{"given":"Monika","family":"Sarkar","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, UCSF, San Francisco, California, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatyana","family":"Kushner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics & Gynecology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, 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