MASLD and Women’s Health: The Roles of PCOS and Pregnancy

As awareness of metabolic dysfunction-associated steatotic liver disease (MASLD) continues to grow, increasing attention is being paid to how reproductive and metabolic conditions uniquely shape risk in women. Among these, polycystic ovary syndrome (PCOS) and pregnancy represent critical but often underrecognized periods where hormonal and metabolic factors intersect to influence liver health.

In this segment from a recent episode of Liver Lineup: Updates and Unfiltered Insights, Meena Bansal, MD, joins hosts Nancy Reau, MD, and Kimberly Brown, MD, to examine the complex relationship between PCOS, pregnancy, and MASLD.

Watch the full episode here.

Bansal emphasizes that PCOS is a well-established risk factor for MASLD and its more advanced form, MASH, largely driven by underlying insulin resistance. While the condition is widely recognized in endocrinology, its implications for liver health are often underappreciated. She notes that patients with PCOS should be evaluated for liver fibrosis using noninvasive tools, and those with evidence of stage 2 or 3 fibrosis may be appropriate candidates for currently approved therapies.

The discussion then shifts to pregnancy as a critical period of risk. Women entering pregnancy with metabolic comorbidities such as obesity or diabetes may already be predisposed to MASLD, and the physiologic changes of pregnancy, including weight gain, can further exacerbate disease progression. According to Bansal, emerging data suggest that MASLD during pregnancy is associated with increased risks of adverse maternal outcomes, including gestational diabetes and preeclampsia, as well as complications for the fetus, such as preterm birth and abnormal growth patterns.

The conversation also touches on the potential for long-term, intergenerational effects. Bansal highlights research suggesting that maternal metabolic health may influence fetal outcomes through epigenetic mechanisms, potentially increasing a child’s lifetime risk of metabolic disease and liver dysfunction. While she says these findings require further validation, they underscore the broader implications of MASLD beyond the individual patient.

Reau and Brown further explore how current therapies fit into this landscape, particularly for younger, premenopausal women. Although GLP-1 receptor agonists have shown benefits in weight loss and metabolic regulation and may even improve menstrual regularity in some patients with PCOS, their use is contraindicated during pregnancy. Bansal points out the challenges this creates in preconception care, including uncertainty around weight regain after discontinuation and its potential impact during pregnancy.

As Bansal notes, more research is needed to better understand how to tailor care for women with MASLD, especially during periods of hormonal and metabolic transition.

Editors’ note: Relevant disclosures for Reau include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for Brown include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal. Relevant disclosures for Bansal include Boeheringer-Ingelheim, Boston Pharma, Fibronostics, GSK, Madrigal, Merck, NOVO Nordisk, and The Kinetix Group.

References

1. DiStefano JK. NAFLD and NASH in Postmenopausal Women: Implications for Diagnosis and Treatment. Endocrinology. 2020;161(10):bqaa134. doi:10.1210/endocr/bqaa134

2. Sarkar M, Kushner T. Metabolic dysfunction-associated steatotic liver disease and pregnancy. J Clin Invest. 2025;135(10):e186426. Published 2025 May 15. doi:10.1172/JCI186426

3. Mass General Brigham. Patients Who Discontinued GLP-1s Had More Weight Gain, Complications During Pregnancy. November 24, 2025. Accessed April 17, 2026. https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/pregnancy-effects-from-discontinued-glp-1-use