title: The Association of Alanine Aminotransferase in Early Pregnancy with Gestational Diabetes.
abstract: Elevated alanine amino transferase, attributed to nonalcoholic fatty liver, is associated with later development of type 2 diabetes mellitus. We sought to determine whether maternal ALT values are associated with subsequent development of gestational diabetes.
  
  
  
  We performed a nested case-control study utilizing prospectively banked serum samples collected in early gestation. We excluded women with known diabetes, liver disease, or alcohol use. We included 83 cases of gestational diabetes mellitus (GDM) and 247 controls matched for prepregnancy body-mass index (BMI) and compared ALT values. We then performed a conditional logistic regression to model the adjusted odds of GDM in women with ALT ≥19 U/L, stratified by prepregnancy BMI.
  
  
  
  The median (interquartile range) ALT in cases was 15 (12, 19) IU/L compared to 13 (11, 18) IU/L in controls (P = 0.07). Among women with a prepregnancy BMI <30 kg/m(2), ALT ≥19 U/L was associated with a fourfold increased odds of GDM (adjusted odds ratio [aOR] 4.56 [1.45, 14.27]), while there was no such association among obese women (aOR 0.36 [0.11, 1.20]). Similarly, each unit increase in log-transformed ALT was associated with a threefold increased odds of GDM in nonobese (aOR 3.15 [1.04,9.54]), but not obese (aOR 3.15 [0.30,3.15]) women.
  
  
  
  The association of high normal ALT and later GDM in nonobese women may reflect the role of hepatic insulin resistance and visceral obesity.
authors.affiliation: 1 Maternal Fetal Medicine Division, Department of OB/GYN, Boston Medical Center, Boston, Massachusetts.
authors.forename: Christina D
authors.initials: CD
authors.lastname: Yarrington
authors.affiliation: 2 Department of Maternal and Fetal Medicine, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: David E
authors.initials: DE
authors.lastname: Cantonwine
authors.affiliation: 3 Department of Diabetes and Hypertension, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Seely
authors.affiliation: 2 Department of Maternal and Fetal Medicine, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: McElrath
authors.affiliation: 2 Department of Maternal and Fetal Medicine, Brigham and Women's Hospital , Boston, Massachusetts.
authors.forename: Chloe A
authors.initials: CA
authors.lastname: Zera
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D015992:Body Mass Index; D016022:Case-Control Studies; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D016640:Diabetes, Gestational / Q000097:blood*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D008099:Liver / Q000378:metabolism; D008137:Longitudinal Studies; D009765:Obesity; D016017:Odds Ratio; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D000410:Alanine Transaminase