Plasma Levels of Alanine Aminotransferase in the First Trimester Identify High Risk Chinese Women for Gestational Diabetes

Abstract

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.

Electronic Health Record Driven Prediction for Gestational Diabetes Mellitus in Early Pregnancy

“…Another relative method to solve the problem of imbalance learning was balanced sampling, such as undersampling 13 , 35 . It mainly consisted of two steps: trading off the balance of the positive samples and the negative with undersampling; training the new generated data set with machine learning algorithms.…”

“…To further investigate first-trimester prediction of GDM, Leng, J. et al . 13 studied plasma levels of alanine aminotransferase, identifying high risk women for gestational diabetes. Savvidou, M. et al .…”

Bile acid metabolites in early pregnancy and risk of gestational diabetes in Chinese women: A nested case-control study

“…After careful visual checking of the shapes of the OR curves of bile acids for GDM, we stratified these bile acid species into categorical variables at specific cutoff points where the risk of GDM started to increase steeply. This method of selection of cutoff points had been used in many of our previous studies [ 26 , 27 ], including analyses of this GDM cohort [ 28 ].…”

Elevated First-Trimester Total Bile Acid is Associated with the Risk of Subsequent Gestational Diabetes

“…reported that pregravid γ-GT may help to identify women at increased risk for GDM 7 . Another research indicated that elevated ALT levels in the first trimester can be used to identify high risk women for subsequent GDM 8 . In the current study, γ-GT levels among women who developed GDM were similarly higher than non-GDM women, but it was not found to be an independent risk factor for GDM.…”

“…reported that γ-glutamyltransferase (γ-GT) measured before pregnancy may help to identify women at increased risk for subsequent GDM 7 . In a large prospective cohort study, researchers reported that elevated asalanine aminotransferase (ALT) levels in the first trimester can be used to identify high risk women for GDM 8 . Another large retrospective study showed that higher levels of fasting blood glucose in first trimester were associated with increased risk of GDM, cesarean section, and macrosomia 9 .…”