Plasma Levels of Alanine Aminotransferase in the First Trimester Identify High Risk Chinese Women for Gestational Diabetes.
Alanine aminotransferase (ALT) predicts type 2 diabetes but it is uncertain whether it also predicts gestational diabetes mellitus (GDM). We recruited 17359 Chinese women with ALT measured in their first trimester. At 24-28 weeks of gestation, all women underwent a 50-gram 1-hour glucose challenge test (GCT) followed by a 75-gram 2-hour oral glucose tolerance test if GCT result was ≥7.8 mmol/L. Restricted cubic spline analysis was used to examine full-range risk associations of ALT levels with GDM. Relative excess risk due to interaction, attributable proportion due to interaction and synergy index were used to estimate additive interaction between high ALT and overweight/obesity for GDM. Finally, 1332 (7.7%) women had GDM. ALT levels were positively associated with GDM risk without a clear threshold. Using ALT levels <22 U/L as the referent, the middle ALT levels (≥22 to <40 U/L) [odds ratio (OR) (95% confidence intervals): 1.41(1.21-1.65)] and high ALT levels (≥40 U/L) [1.62 (1.31-2.00)] were associated with increased GDM risk. Maternal overweight/obesity greatly enhanced the OR of ALT ≥22 U/L from 1.44 (1.23-1.69) to 3.46 (2.79-4.29) with significant additive interactions. In conclusion, elevated ALT levels in the first trimester even within normal range predicted GDM risk, further enhanced by overweight/obesity.
Tianjin Women and Children's Health Centre, Tianjin, China.|Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
Junhong
J
Leng
Tianjin Women and Children's Health Centre, Tianjin, China.
Cuiping
C
Zhang
Tianjin Women and Children's Health Centre, Tianjin, China.
Peng
P
Wang
Tianjin Women and Children's Health Centre, Tianjin, China.
Nan
N
Li
Tianjin Women and Children's Health Centre, Tianjin, China.
Weiqin
W
Li
Tianjin Women and Children's Health Centre, Tianjin, China.
Huikun
H
Liu
Tianjin Women and Children's Health Centre, Tianjin, China.
Shuang
S
Zhang
Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
Gang
G
Hu
Population Cancer Research Program and Department of Pediatrics, Dalhousie University, Halifax, Canada.
Zhijie
Z
Yu
Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and The Chinese University of Hong Kong, Hong Kong SAR, China.
Ronald Cw
RC
Ma
Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and The Chinese University of Hong Kong, Hong Kong SAR, China.
Juliana Cn
JC
Chan
Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.
Xilin
X
Yang
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D015992:Body Mass Index; D002681:China; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016017:Odds Ratio; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D012307:Risk Factors
D000410:Alanine Transaminase