Abstract
BACKGROUND & AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD) are rising causes of liver-related morbidity and mortality worldwide. The burden among women of childbearing age (15-49 years) is not well defined. We quantified global and regional trends from 2010 to 2021 and projected prevalence through 2035. METHODS: Prevalence, incident cases, and disability-adjusted life-years (DALYs) among women of childbearing age were estimated using the Global Burden of Disease 2021 framework. Temporal trends were evaluated using Joinpoint regression to estimate annual percent change. Inequality was assessed using the slope and concentration indices, and prevalence was projected using Bayesian age-period-cohort models. RESULTS: Between 2010 and 2021, global MASLD prevalence rose by 13.8%, reaching 15,759 per 100,000 population in 2021. The highest burden was observed in the Eastern Mediterranean region (24,530 per 100,000 population), with the most pronounced increases seen in high sociodemographic index countries (+20.0%) and the Western Pacific region (+21.9%). Conversely, ALD prevalence declined by 6.8% to 11.0 per 100,000 population, with notable declines in Europe (-15.5%) but modest increases in the Western Pacific (+10.5%) and Eastern Mediterranean (+3.7%). The burden of both MASLD and ALD rose steadily with age and peaked among women aged 45-49 years. Despite a higher prevalence, MASLD contributed modest DALY rates (20.4 per 100,000 population), whereas ALD, although less prevalent, imposed a greater burden (29.1 per 100,000 population). By 2035, MASLD prevalence is projected to reach 17,393 per 100,000 population (+10.4%), and ALD prevalence is projected to reach 11.5 per 100,000 population (+4.5%). CONCLUSIONS: MASLD is rapidly increasing among women of childbearing age, with marked regional and socioeconomic disparities, whereas the burden of ALD appears to be in decline. IMPACT AND IMPLICATIONS: Metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-related liver disease (ALD) among women of childbearing age are often overlooked despite significant maternal and intergenerational health consequences. Our analysis shows a rising prevalence of MASLD and a modest decline in ALD, with marked regional and socioeconomic disparities, and projects continued MASLD growth through 2035. These findings are important for clinicians, researchers, and policymakers, given the associated maternal, neonatal, and intergenerational risks. Integrating metabolic and reproductive health services alongside equitable policy interventions may help mitigate these concerning trends.