Objective: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in the Western world and has a strong relationship to obesity and diabetes. NAFLD has not been well studied in pregnant women. We studied a series of lean, obese, and gestational diabetic pregnant women to determine whether (1) liver enzymes could predict the presence of NAFLD and (2) to establish the prevalence of NAFLD in an obstetric population. Methods: A total of 59 pregnant women of various gestational ages and maternal weights who denied a history of alcohol intake or pre-existing liver disease. Pregnant women underwent liver enzymes measurement and abdominal ultrasound, and blood samples were obtained for assay of adiponectin and leptin. The presence of hepatic steatosis was established using standardized ultrasound criteria. Setting: Single-center university affiliated hospital Population: 59 pregnant women presenting for prenatal care in a general obstetrical clinic. Main outcomes: Liver enzyme measurements and a number of morphometric and endocrine factors in pregnant women with and without sonographic evidence of NAFLD. Results: NAFLD was found in 48.9% of pregnant women and almost equally distributed between lean and obese women. The incidence of NAFLD in gestational diabetic pregnancies (50%) was comparable to the non-diabetic group. Liver function tests (AST and ALT) were not elevated in any pregnant women with or without NAFLD. Serum levels of leptin were greater in the NAFLD group and conversely, serum levels of adiponectin were less in the NAFLD group. Conclusions: Liver enzymes AST and ALT are not useful tests in screening for NAFLD in pregnant women. Studies to further define the pathophysiology and clinical significance of NAFLD in pregnant women are warranted as it may alter the obstetrical management. Screening of pregnant women at standard ultrasound (US) exams might be a useful approach to patient management.