Role of Liver Parameters in Preterm Birth: A Prospective Cohort Study
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Published on: November 20, 2015
Qingxiu Li1, Juan Yang2, Jiayi Chen1
1Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China; Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China.
Objectives:
To investigate the association between liver dysfunction during pregnancy and the risk of preterm birth (PTB).
Methods:
We conducted a prospective birth cohort study in China that included 23,194 women with singleton pregnancies. Several biomarkers, including total bile acids (TBA), gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), the AST-to-ALT ratio, and total bilirubin (TBiL), were measured in the first and third trimesters. The primary outcome was PTB (delivery before 37 weeks of gestation).
Results:
The incidence of PTB among our participants was 5.7%. After multivariable adjustment, increased levels of TBA, GGT, ALT, and AST, as well as abnormal liver function tests (LFTs) in early pregnancy, were associated with a higher risk of PTB. An increased AST-to-ALT ratio was associated with a lower risk of PTB. Furthermore, a nonlinear test revealed a linear association between PTB and TBiL, TBA, GGT, ALT, AST, and the AST-to-ALT ratio in the first trimester. The association between liver enzyme levels and PTB in late pregnancy was similar to that observed in early gestation. In addition, TBiL in late pregnancy was negatively correlated with PTB. Interestingly, a consistent association was observed between GGT and PTB, whether iatrogenic or spontaneous, in both the first and third trimesters (p <0.05).
Conclusions:
Associations have been observed between liver enzyme levels in both early and late gestation and the risk of PTB. Consequently, future mechanistic and interventional studies are warranted to further investigate these links.