Ma Wen-Xia, Xu Zhou, Xiao Rui, Tang Xiao-Jun, Fu Li-Juan, Xiang Yan-Xiao, Yu Shao-Min, Ding Yu-Bin, Zhong Zhao-Hui
Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China, School of Public Health, Chongqing Medical University, Chongqing, China.
Department of Obstetrics and Gynecology, Sichuan Jinxin Xinan Women and Children's Hospital, Chengdu, Sichuan, China.
PLoS One. 2025 May 14;20(5):e0322581. doi: 10.1371/journal.pone.0322581. eCollection 2025.
Elevated serum alanine aminotransferase (ALT) levels in early pregnancy and gestational diabetes mellitus (GDM) are linked to an increased rate of large for gestational age (LGA) births. Additionally, elevated ALT levels raise the risk of developing GDM, but it remains unclear whether GDM mediates the effect of ALT on neonatal birth weight. This study examines whether GDM mediates this relationship. We conducted a retrospective cohort study with participants from Jinxin Women's and Children's Hospital who delivered single live births between 2020 and 2023. A multifactorial logistic regression model assessed the relationship between early pregnancy ALT levels, GDM incidence, and LGA births. A mediation model evaluated GDM's role in the impact of elevated ALT on neonatal birth weight. Our study included 12,057 patients. After adjusting for confounders, the difference in LGA rates between elevated and normal ALT groups was significant (OR: 1.248, 95% CI: 1.001-1.556, P = 0.049). The GDM incidence difference between these groups was also significant (OR: 1.564, 95% CI: 1.306-1.873, P < 0.01), as was the LGA incidence difference between GDM and non-GDM groups (OR: 1.306, 95% CI: 1.129-1.511, P < 0.01). After adjusting for confounders, we found that elevated ALT levels in early pregnancy and GDM both affected neonatal birth weight. Specifically, elevated ALT levels had a direct impact on neonatal birth weight (β = 0.0291, 95% CI: 0.0100-0.0635), while GDM had an indirect effect (β = 0.0025, 95% CI: 0.0012-0.0056), with GDM accounting for 8.1% of the mediation effect. Our study shows that GDM partly mediates the effect of elevated ALT on neonatal birth weight, highlighting the importance of early ALT and glucose screening in routine prenatal care. Healthcare providers should consider including ALT testing in pregnancy protocols and focus on blood glucose control in patients with elevated ALT to reduce the risk of LGA births.
妊娠早期血清丙氨酸氨基转移酶（ALT）水平升高与妊娠期糖尿病（GDM）和大于胎龄（LGA）儿出生发生率增加有关。此外，ALT水平升高会增加患GDM的风险，但GDM是否介导了ALT对新生儿出生体重的影响尚不清楚。本研究旨在探讨GDM是否介导了这种关系。我们进行了一项回顾性队列研究，研究对象为2020年至2023年间在金鑫妇女儿童医院单胎活产的产妇。多因素逻辑回归模型评估了妊娠早期ALT水平、GDM发病率与LGA儿出生之间的关系。中介模型评估了GDM在ALT升高对新生儿出生体重影响中的作用。我们的研究纳入了12,057名患者。在调整混杂因素后，ALT升高组与正常组之间的LGA发生率差异具有统计学意义（OR：1.248，95%CI：1.001-1.556，P = 0.049）。两组之间的GDM发病率差异也具有统计学意义（OR：1.564，95%CI：1.306-1.873，P < 0.01），GDM组与非GDM组之间的LGA发生率差异同样具有统计学意义（OR：1.306，95%CI：1.129-1.511，P < 0.01）。在调整混杂因素后，我们发现妊娠早期ALT水平升高和GDM均会影响新生儿出生体重。具体而言，ALT水平升高对新生儿出生体重有直接影响（β = 0.0291，95%CI：0.0100-0.0635），而GDM有间接影响（β = 0.0025，95%CI：0.0012-0.0056），GDM占中介效应的8.1%。我们的研究表明，GDM部分介导了ALT升高对新生儿出生体重的影响，凸显了在常规产前检查中早期进行ALT和血糖筛查的重要性。医疗保健提供者应考虑将ALT检测纳入妊娠方案，并关注ALT升高患者的血糖控制，以降低LGA儿出生的风险。
