[Association between liver function indicators in early pregnancy and gestational diabetes mellitus]

Objective: To explore the association of liver function indicators in early pregnancy and gestational diabetes mellitus (GDM). Methods: From June 2021 to December 2022, pregnant women who underwent prenatal check-ups at week 24-28 were recruited from the case group and control group in a ratio of 1∶2 at Ma'anshan Maternal and Child Health Hospital. The liver function indicators of early pregnancy were collected from the electronic medical record system. The restricted cubic spline (RCS) was used to evaluate whether there was a nonlinear association between liver function in early pregnancy and the risk of GDM. The logistic regression model was used to assess the association between liver function indicators in early pregnancy and the risk of GDM, and stratified analysis was conducted according to age, pre-pregnancy BMI, and family history of diabetes. Results: This study included a total of 298 cases in the case group and 630 pregnant women in the control group. Early pregnancy liver function alanine aminotransferase (Q₄ vs. Q₁: OR=2.18, 95%CI:1.42-3.34, P<0.001), aspartate aminotransferase (Q₄ vs. Q₁: OR=1.61, 95%CI:1.01-2.57, P=0.044), alanine aminotransferase/aspartate aminotransferase (Q₄ vs. Q₁: OR=1.83, 95%CI:1.18-2.82, P=0.007), γ-glutamyl transferase (Q₄ vs. Q₁: OR=2.49, 95%CI:1.53-4.05, P<0.001), cholinesterase (Q₄ vs. Q₁: OR=1.65, 95%CI:1.05-2.57, P=0.029), and hepatic steatosis index (Q₄ vs. Q₁: OR=3.27, 95%CI:1.78-6.03, P<0.001) were significantly associated with the risk of GDM. In the stratified analysis, the majority of liver enzymes were significantly associated with GDM in people<35 years old, without family history of diabetes and normal weight, while only cholinesterase was associated with GDM in those≥35 years and with a family history of diabetes (≥35 years old: OR=2.99, 95%CI:1.52-5.87, P=0.001; family history of diabetes: OR=1.61, 95%CI:1.17-2.23, P=0.004). Only GGT was associated with GDM in overweight people (OR=1.26, 95%CI:1.02-1.55, P=0.032). Conclusion: Early pregnancy liver function indicators are significantly associated with an increased risk of GDM. Therefore, increasing the screening of liver function indicators in early pregnancy may be beneficial for identifying high-risk groups of GDM.