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| Study of the relationship between the serum alanine aminotransferase level of pregnant women before pregnancy and their risk of gestational diabetes mellitus |
| 1.Graduate School of Peking Union Medical College, Beijing, 100730; 2. National Research Institute for Health and Family Planning; 3. Maternal and Child Health Hospital of Haidian District; 4. Washington University in St. Louis, MO, 63130, USA. |
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Abstract To explore the relationship between the level of serum alanine aminotransferase (ALT) of pregnant women before pregnancy and their risk of gestational diabetes mellitus (GDM). Methods: A retrospective cohort study was conducted from the start of participating National Free Pre-pregnancy Check-up Project (NFPCP) through the entire pregnancy course until the time of GDM diagnosis as end point. People enrolled in this study were 1398 pregnant women who had participated in NFPCP and then established obstetric archives and gave birth at the Obstetrics Clinic of the Maternal and Child Health Hospital of Haidian District in Beijing from January 2013 to October 2017. Relevant information about diagnosis and treatment from baseline to GDM outcomes were collected retrospectively. Multivariable adjusted logistic regression models were used to evaluate the effect of the ALT level of these women before pregnancy on the risks of GDM, and the additive interaction effects between the BMI value of these women before pregnancy as modifiers and their ALT level was analyze. Results: Compared with the normal range (0-40 U/L) of ALT level of women before pregnancy, the odds ratio (OR) of GDM risk in the women with elevated serum ALT (ALT level > 40U/L) was 2.52 (95% CI 1.39-4.58) after multivariable adjustment. The average risk of GDM increased by 31.7% (P<0.001) for ALT increment of 10U/L within normal range comparing with ALT level<10 U/L. Moreover, the women who were overweight or obesity with elevated serum ALT level before pregnancy had significantly enhanced their risks of GDM about 6.72 times, compared with the women who had BMI value < 24 with normal ALT level, with an OR of 7.72 (95 % CI 3.20-18.60) in the stratification analysis. Finally, in the additive interaction analysis, positive interaction effects were found the BMI value of the women before pregnancy had forward additive interaction for the association between their serum ALT level and their GDM occurrence, which’s relative excess risk due to interaction (RERI) was 4.38. Conclusion: Elevated serum ALT level of pregnant women before pregnancy can significantly increase their risk of GDM, and positive correlation is found between serum ALT level increasing and the risk of GDM. In addition, overweight or obesity has a synergistic effect on the increasing risk of GDM caused by elevated ALT level of pregnant women before pregnancy.
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