Reply to ‘Pregnancy and liver health: delivering new collaborations to advance the MASLD and MASH field’

We thank Borges Manna and Ovadia for their comments on our recent Perspective (Envisioning how to advance the MASH field. Nat. Rev. Gastroenterol. Hepatol. 21, 726–738 (2024))¹ and for highlighting the importance of including pregnancy as a lens through which to further the MASLD public health agenda (Pregnancy and liver health: delivering new collaborations to advance the MASLD and MASH field. Nat. Rev. Gastroenterol. Hepatol. https://doi.org/10.1038/s41575-025-01094-4 (2025))².

Metabolic dysfunction-associated steatotic liver disease (MASLD; formerly known as nonalcoholic fatty liver disease)³ is now the leading cause of end-stage liver disease requiring liver transplantation in women⁴. Owing to its slow progression, early identification — potentially decades before complications arise — presents a critical opportunity for timely intervention to prevent cirrhosis, adverse outcomes and mortality. Though rare, cirrhosis in pregnancy worsens fetal outcomes⁵. Antenatal and postpartum periods present ideal windows for early detection.