Why Does Fatty Liver Happen During Pregnancy? Safe Nutrition Tips to Support Your Liver

We often don't pay attention until there's a problem - pregnancy has made women wonder about many things that go on in their bodies! For example, like one mom-to-be shared her experience with me that last week I were celebrating my growing bump but during my routine appointment I got bad news - they did a liver ultrasound and found that my liver enzymes are high (insulin resistant) and that I now have fatty liver.

And suddenly you're left thinking "how did this happen?" Did I eat something wrong? Is my baby ok? Do I need to stop all fats? Do I need to start losing weight?" So if you've asked yourselves some of those questions... take a deep breath... But what does having fatty liver during pregnancy even mean?

This isn’t just a simple case of you eating too much fat—it’s far more complex than that. There is rarely one single cause. Everything from metabolic health and insulin resistance, body composition, genetics, cholesterol and triglyceride levels, gestational diabetes, and more comes into play.

Lately I’ve been seeing research highlight another term for fatty liver: metabolic dysfunction-associated steatotic liver disease (or MASLD, which used to be called nonalcoholic fatty liver disease [NAFLD]). It’s become an important disorder to recognize during pregnancy.

Now here’s where things get really fascinating—and how nutrition plays a big role: You should be skipping the restrictive diets (think no carbs, dramatic calorie cuts, “liver detox” supplements, lemon teas, or quick fixes for shedding those pesky extra pounds).

Try not to focus too much on making sure on these things, each individual meal has all these components. Rather, approach food as an opportunity every day to take care of your liver, blood sugar, digestion, energy and nutrition throughout your pregnancy.

Every time you sit down for a meal, imagine you’re having a conversation with your baby about how well everything is going with your metabolism. Your goal isn’t necessarily to make the entire conversation perfect — rather just a bit more balanced.

This guide will explain why fatty liver occurs during pregnancy, discuss some potential risk factors that contribute to this condition, give ideas on pregnancy-friendly fatty liver diet (and also mention foods to avoid doing on your own) and share tips on how to talk through things when you feel confused or frustrated by anything related to eating for your health and your baby’s health.

Why Does Fatty Liver Happen During Pregnancy?

It’s rare to find just one cause – usually fatty liver develops because of a complex mix of metabolic and genetic factors. Even pregnancy causes some change to your insulin sensitivity, fat metabolism and energy requirements. But, here you can see:

1. Insulin resistance

During pregnancy your body responds differently to insulin ensuring there's enough glucose around to power the development of the growing fetus. Usually this means as you progress through your pregnancy you become less sensitive to the effects of insulin.1

If you go on to develop an increase in insulin resistance throughout your pregnancy you may also start to struggle with regulating your blood glucose (alongside some other things related to your metabolism of fats), due to increased levels of certain fatty acids floating around your system. This could result in more fat being delivered to the liver leading to hepatic fat accumulation. 2

That’s one reason fatty liver and gestational diabetes often go hand-in-hand. And that’s why telling someone to just “avoid fatty foods” is only part of the story. Instead, think about whole metabolic health.

2. Pre-existing metabolic health

But sometimes it turns out that this condition didn’t start from pregnancy after all. In fact, it’s possible that you might have had fatty liver long before becoming pregnant — but didn’t realize it until your prenatal care began.

As recent reviews note, pregnancy represents “an important window for identifying individuals with previously unrecognized MASLD.” Meaning about your previous unchecked fatty liver disease, you may find it in your pregnancy checkups.

So this is why when you get diagnosed with fatty liver disease during your pregnancy don’t say ‘My pregnant life has cause me to have this fatty liver disease’?

3. Gestational diabetes

In addition, research has found there is also a relationship between fatty liver and gestational diabetes as well. 3 Gestational diabetes is diabetes type type that happens during pregnancy to mother due to metabolic changes. And it seems to work both ways — metabolic dysfunction increases the risk for developing gestational diabetes, while worsened metabolic health could also lead to fatty liver. So this is why balanced carbohydrate intake comes into play here too!

Not elimination of carbohydrates

But balanced carbohydrate intake

4. Excess body fat

The higher your body fat mass – especially if you also have insulin resistance – the greater your risk for MASLD, which has been associated with obesity and increased hepatic lipids due to altered metabolism. During pregnancy, metabolic shifts that are normal during gestation might exacerbate pre-existing issues.

However, before anyone starts teaching pregnant women on their weight and other factors, let’s remember that we shouldn’t be engaging in pregnancy body-shaming. A woman might have a fatty liver but she may not look anything like the “typical” patient that comes to mind when you hear the word.

Two pregnant women with same 80 kg have possibly different body appearances. One may look more lean than other. Both have possibly different body composition and different fat mass. One may have fatty liver, other have not.

And another scenario, it is also possible you may see one woman with 50 kg and she have fatty liver. And another woman with 80kg, and she have normal pregnancy. While body weight certainly plays a part in this condition, there are other factors such as genetics, metabolic health, glucose regulation, and more involved in developing a fatty liver.

5. High triglycerides

Your liver plays a role in how you metabolize fats. Triglycerides and other blood lipid levels often play a part in the ‘metabolic setting’ that makes it easier for us to accumulate fat around our livers.

So while we focus on seeing what’s happening with an ultrasound scan of your liver, your clinician will also want to know about your glucose, your blood lipids and liver enzymes, your blood pressure and many other indicators of health — all as they evaluate if you have fatty liver.

6. Genetics

Certain individuals possess a natural tendency to acquire fatty livers due to biological factors. 4 Thus, if you question why your companion has not developed fatty liver in spite of having similar diet, bear in mind that proper nutrition is complicated.

What Can You Do If You Have Fatty Liver During Pregnancy?

Thus, I will attempt to shift the emphasis of this discussion away from “What are the foods I should be avoiding?” and change it to “What are the ways of ensuring the leading character of every meal?”

This is because being pregnant is not a case where one should go for very strict diet restrictions.

1. Build meals around a protein + fiber + carbohydrate combination

You shouldn’t just eat carbohydrates by themselves; pair them with proteins and fiber.
Some good combinations include:

• Oatmeal + plain yogurt + berries or other fruit
• Whole grain chapatti + eggs + veggies
• Brown rice + lentils + salad
• Chickpeas + veggies + whole grain chapatti
• Plain yogurt + fruit + nuts, if appropriate for you
• Fish or chicken + veggies + moderate serving of whole grains

This method makes your meals more filling and allows for better blood sugar stability than meals with refined carbohydrates alone. The idea is not to have every dish be “perfect.” All you have to do is to make your meals more wholesome.

2. Don't Diet, Improve the Pattern

This is more vital in ensuring that the right choice of words is used when addressing pregnant women. Pregnancy is no time for a crash diet to reduce weight. If you are at your weight before pregnancy or you are overweight and your metabolic risk is affected, then you shouldn't be trying to reduce calories.

Best practices

Don’t think of calorie counting but think of nutritional value of food.

Considerations:

• A sugary breakfast needs to be substituted with proteins.
• A juice needs to be substituted with a fruit.
• Fried snacks can be replaced with roasted or lightly processed items.
• Snack foods should be replaced with yogurt, fruit, nuts or other healthy foods.

I share some quick snack ideas, you can check out this!

• What you can really eat is portions that are comfortable for you.
• A doctor or dietitian can help determine whether or not you have gained the right amount of weight during your pregnancy.

3. High Triglycerides → Choose More Unsaturated Fats

When triglycerides and other metabolic markers are out of whack, suggesting to “stay away from fats” is an overly simplistic response. What types of fats to eat?

You may need the following foods:

• Nuts
• Seeds
• Avocado
• Unsaturated vegetable oils
• Pregnancy-safe fish

Food choices to limit often:

• Deep-fried foods
• Foods with high saturated fat levels
• Highly processed foods

The aim is not to have a fat-free diet during pregnancy.

4. Use the “Add Before You Subtract” Method

Do not just prepare a long list of food to avoid, but make your meals healthier instead. Instead of taking away some items, add something good before removing anything from your diet. Are you eating rice? Then you can include vegetables along with lentils and meat. Are you planning to have bread or wraps? Then you can add eggs and vegetables with it. Are you snacking? You should include some protein or fiber instead of having simple carbohydrates. Would you like to have some sweets? You should stick to reasonable portions in order to turn the food into acceptable one instead of forbidden.

5. Sugary Drinks → Make Water Your Default

Sweet drinks can introduce a lot of sugar while lacking the quality of filling foods.

What you can do:

Use water as the go-to beverage. You can select other permitted unsweetened beverages based on your pregnancy diet.

Cut down on:

• Soda
• Sugary juice
• Sweet iced tea
• Sweet coffee varieties
• Energy beverages

• Be aware that whole fruit is different from fruit juice. Whole fruit has fibers and needs more chewing, hence it is easier to eat it on purpose.

6. Add Pregnancy-Appropriate Movement

If your doctor has approved you to participate in physical activities, you may want to consider incorporating movement into your daily routine.

Start slow:
Take a short walk and then another walk and so on.
You do not need to do complicated exercises.

Some women might find that going for a walk after eating is a good option for them, especially if they want to manage their blood sugar levels effectively, but this will depend on what has been advised during their pregnancy. If your doctor has prevented you from exercising, you have to listen to this advice.

7. What If the Cause Isn't Something You Can “Fix” With Food?

You can't change your genes, but you can work on the factors you can influence—balanced meals, glucose management, physical activity when appropriate, and regular medical follow-up.

8. Be careful with liver detox teas and supplements

A diagnosis can expose you to marketing. Immediately, social media become crowded with:

• "Liver detox."
• "Detox herbal tea."
• "Losing fat drops."
• "Natural hepatic restoration."

Stop before making any purchases.

"Natural" doesn’t equal "safe during pregnancy".

There is very little evidence that shows the safety of the majority of supplements during pregnancy, and some herbal products can be known to interact with medications or cause undesired effects during use. Talk to your obstetrician or qualified healthcare professional about any supplements, including herbal products, before starting use.

When Should You Contact Your Doctor?

Pregnancy-related fatty liver must undergo appropriate medical assessment. Your health care provider may take into account your symptoms, medical history, blood testing, metabolic markers, imaging testing and stage of pregnancy when assessing the diagnosis.

Seek immediate medical aid if you face troubling symptoms such as:

• Severe or steady stomach pain
• Severe vomiting
• Yellow skin or eyes
• Serious confusion or drowsiness
• Strong headache or blurry vision
• Significant swelling combined with high blood pressure
• Bleeding or other severe symptoms of pregnancy
• Being in an extremely horrible condition.
• Such symptoms can accompany several pregnancy complications and cannot be treated by a patient as "fatty liver only".

In particular, the acute fatty liver of pregnancy is considered a health emergency and should be urgently assessed by an obstetrician rather than treated through diet changes. 5

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