Yang Huibin, Tang Tianyi, Qian Qianlei, Zhang Xiaohua, Liu Yinan, Zhou Xiaoyan, Zhang Yanling, Jin Longmei, Chen Xiaotian
Minhang Maternal and Child Health Hospital.
Nantong Third People's Hospital, Affiliated Nantong Hospital of Nantong University.
J Epidemiol. 2025 May 5;35(5):230-236. doi: 10.2188/jea.JE20240233. Epub 2025 Mar 31.
Spontaneous pregnancy loss (SPL) precedes an increased risk of reduced fertility, while its etiology mechanism remains largely unknown. Liver dysfunction presenting in early pregnancy may represent a pre-existing undiagnosed liver condition affecting fetal development. Here, we investigated whether maternal abnormal liver function in early pregnancy contributed to the incidence of SPL.
Data on pregnant women were leveraged from the Maternal Health Care Information System in Shanghai City from 2017 to 2021. Liver dysfunction status was defined as having any elevated liver function biomarker levels (LFBs) at the first antenatal visit. SPL cases were defined as fetal death occurring before 28 weeks gestation. Generalized linear models were used to estimate crude and adjusted risk ratios (RRs and aRRs, respectively) and 95% confidence intervals (CIs).
Among 10,175 leveraged pregnant women, 918 (9.0%) SPL cases were recorded. Maternal liver dysfunction in early pregnancy was associated with a 49% increased risk of SPL (RR 1.49; 95% CI, 1.22-1.84). This positive association persisted after adjustment for covariates (aRR 1.55; 95% CI, 1.26-1.92). Higher γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP) levels were also linked with increased risk of SPL in a linear fashion (aRRs per 1 standard deviation increase: 1.13; 95% CI, 1.08-1.17 and 1.13; 95% CI, 1.07-1.20, respectively). Similar magnitudes of associations were observed between normal weight and overweight pregnant women in subgroup analysis.
We provide new evidence that maternal abnormal liver function in early pregnancy, as well as GGT and ALP, predisposes to an increased risk of SPL.
自然流产（SPL）发生后生育力降低的风险会增加，但其病因机制在很大程度上仍不清楚。妊娠早期出现的肝功能障碍可能代表一种先前未被诊断出的影响胎儿发育的肝脏疾病。在此，我们调查了妊娠早期孕妇肝功能异常是否会导致自然流产的发生率增加。
利用上海市孕产妇保健信息系统2017年至2021年期间的孕妇数据。肝功能障碍状态定义为首次产前检查时肝功能生物标志物水平（LFBs）有任何升高。自然流产病例定义为妊娠28周前发生的胎儿死亡。采用广义线性模型估计粗风险比和调整后风险比（分别为RRs和aRRs）以及95%置信区间（CIs）。
在10175名被利用的孕妇中，记录了918例（9.0%）自然流产病例。妊娠早期孕妇肝功能障碍与自然流产风险增加49%相关（RR 1.49；95% CI，1.22 - 1.84）。在对协变量进行调整后，这种正相关仍然存在（aRR 1.55；95% CI，1.26 - 1.92）。较高的γ-谷氨酰转移酶（GGT）和碱性磷酸酶（ALP）水平也与自然流产风险增加呈线性相关（每增加1个标准差的aRRs分别为：1.13；95% CI，1.08 - 1.17和1.13；95% CI，1.07 - 1.20）。在亚组分析中，正常体重和超重孕妇之间观察到了相似程度的关联。
我们提供了新的证据，表明妊娠早期孕妇肝功能异常以及GGT和ALP会使自然流产风险增加。
