Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2020 Jul 6;35(26):e198. doi: 10.3346/jkms.2020.35.e198.
Nonalcoholic fatty liver disease (NAFLD) is now considered as a hepatic manifestation of metabolic syndrome and elevated alanine aminotransferase (ALT) is commonly related to NAFLD in the absence of viral hepatitis or alcohol abuse. Previous studies have indicated that elevated ALT is associated with diabetes or metabolic syndrome in adults, but the clinical significance of ALT or NAFLD in pregnancy has not been well determined. The objective of this study was to determine the association between elevated ALT in early pregnancy and the development of gestational diabetes or preeclampsia in late pregnancy.
In this retrospective cohort study, pregnant women who met the following inclusion criteria were included: 1) singleton pregnancy; 2) ALT levels were measured in antenatal outpatient clinic at 4-20 weeks of gestation; 3) patients were screened for gestational diabetes and delivered in Cheil General Hospital and Women's Healthcare Center. Cases with viral hepatitis or other liver diseases were excluded. The early ALT levels were divided into two groups (normal ALT [≤ 95th percentile] and elevated ALT [> 95th percentile]), and the frequency of gestational diabetes and preeclampsia was compared between the two groups of cases. Gestational diabetes was screened and diagnosed by two-step procedure (50 g oral glucose challenge test and 75 g glucose challenge test with World Health Organization [WHO] criteria).
A total of 2,322 women met the inclusion criteria. Cases with elevated early ALT levels (> 95th percentile) had a higher risk of subsequent gestational diabetes and preeclampsia (gestational diabetes by WHO criteria, 2.1% in normal ALT vs. 6.5% in elevated ALT, < 0.01; preeclampsia, 1.0% in normal ALT vs. 4.1% in elevated ALT, < 0.05). This relationship between elevated ALT and increased risk of gestational diabetes/preeclampsia remained significant after adjustment for maternal age and pre-pregnancy body mass index.
Elevated unexplained ALT in early pregnancy is associated with the risk of subsequent development of gestational diabetes and preeclampsia in late pregnancy.
非酒精性脂肪性肝病（NAFLD）现在被认为是代谢综合征的肝脏表现，在没有病毒性肝炎或酒精滥用的情况下，丙氨酸氨基转移酶（ALT）升高通常与 NAFLD 有关。先前的研究表明，ALT 升高与成人糖尿病或代谢综合征有关，但 ALT 或妊娠期间的 NAFLD 的临床意义尚未得到很好的确定。本研究的目的是确定早期妊娠时 ALT 升高与晚期妊娠时妊娠期糖尿病或子痫前期的发展之间的关系。
在这项回顾性队列研究中，符合以下纳入标准的孕妇被纳入研究：1）单胎妊娠；2）在妊娠 4-20 周的产前门诊测量 ALT 水平；3）在 Cheil 综合医院和妇女保健中心筛查妊娠期糖尿病并分娩。排除病毒性肝炎或其他肝脏疾病的患者。将早期 ALT 水平分为两组（正常 ALT [≤第 95 百分位数]和升高的 ALT [>第 95 百分位数]），并比较两组病例中妊娠期糖尿病和子痫前期的发生频率。妊娠期糖尿病通过两步法（50g 口服葡萄糖耐量试验和符合世界卫生组织[WHO]标准的 75g 葡萄糖耐量试验）筛查和诊断。
共有 2322 名符合纳入标准的妇女。早期 ALT 水平升高（>第 95 百分位数）的病例发生随后的妊娠期糖尿病和子痫前期的风险较高（符合 WHO 标准的妊娠期糖尿病，正常 ALT 组为 2.1%，升高的 ALT 组为 6.5%，<0.01；子痫前期，正常 ALT 组为 1.0%，升高的 ALT 组为 4.1%，<0.05）。在校正了母亲年龄和孕前体重指数后，ALT 升高与妊娠期糖尿病/子痫前期风险增加之间的关系仍然显著。
早期妊娠中无法解释的 ALT 升高与晚期妊娠中妊娠期糖尿病和子痫前期的发生风险相关。
