The Association Of Liver Enzymes And Risk Of Gestational Diabetes Mellitus In Early Pregnancy

Objective: To analyze the relationships between serum liver enzymes and gestational diabetes mellitus(GDM)in early pregnancy.To explore risk factors for GDM,and provide a theoretical basis for early prediction of GDM.Methods: The participants were enrolled in the Tongji Maternal and Child Health Cohort(TMCHC)from January 2013 to May 2016.We collected the general social demographic data,family history of disease,and life style of each participants when they came for their initial perinatal visits,and followed them up throughout their pregnancy.We measured maternal serum alkaline phosphatas(ALP),gama-glutamyltranspeptidase(GGT),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)levels at 6-18 weeks of gestation.All participants underwent a 75 g oral glucose tolerance test for diagnosis of GDM at 24-28 gestational weeks.We excluded participants who had history of diabetes,hepatobiliary diseases,abortions,stillbirths and multiple pregnancies.The characteristics of the participants were compared using the t test or variance test for continuous variables,?2 test for categorical variables.Logistic regression models were used to explore the relationships between the quintiles of ALP and GGT and risk of GDM.To observe potential modifier,stratification analysis was performed by pre-pregnancy body mass index(BMI)(<24 kg/m2 and ?24 kg/m2).Sensitivity analyses were performed in participants whose age<35 years,without family history of diabetes,and without gestational hypertension,respectively.Results: A total of 2483 women were enrolled in the study,and 230(9.3%)women were diagnosed with GDM.More women had family history of diabetes in GDM group than non-GDM group.The age,pre-pregnancy BMI,systolic blood pressure(SBP)and diastolic blood pressure(DBP)were higher in GDM group than non-GDM group.ALP and GGT levels were significantly higher in GDM group when compared with non-GDM group.But there were no significant differences of maternal serum ALT and AST levels between GDM and non-GDM group.After adjustment for confounding factors,compared with Q1 groups of ALP and GGT(13.0-37.0 U/L for ALP,3.0-9.0 U/L for GGT),individuals in the Q5 groups of ALP and GGT(52.1-92.0 U/L for ALP,19.1-92.0 U/L for GGT)was correlated significantly with the risk of GDM,the odds ratio(OR)and the 95% confidence interval(CI)were 2.49(1.62,3.82)and 1.72(1.10,2.68),respectively.In women with lower pre-pregnancy BMI,compared with Q1 groups,the OR(95% CI)of the Q5 groups of ALP and GGT were 2.25(1.41,3.60)] and 1.84(1.10,3.07)for GDM,respectively.In women with higher pre-pregnancy BMI,Q5 vs.Q1 ALP [OR(95% CI): 3.94(1.06,14.63)] was positively associated with GDM,but GGT was negatively associated with GDM.We combined ALP and GGT,the highest ALP and GGT increased the risks of GDM [OR(95% CI): 6.16(2.48,15.35)] significantly,compared with the lowest ALP and GGT.The results were consistent in sensitivity analyses of ALP and GGT levels and the risk of GDM.Conclusions: In early pregnancy,higher levels of ALP and GGT are independent risk factors for GDM,and ALP may be a better predictor of GDM risk than GGT.The combination of elevated ALP and GGT levels increased the risks of GDM significantly.