532: Influences of prepregnancy liver function on the incidence of gestational diabetes needing insulin treatment

Abstract

Elevated liver enzymes, attributed to nonalcoholic fatty liver, is associated with later development of type 2 diabetes mellitus. The objective of this study was to assess whether prepregnancy liver enzyme levels are associated with subsequent risk of gestational diabetes mellitus needing insulin treatment (GDM+IT). Data from a total of 325,208 women who participated in the National Health Screening Examination (NHSE) between 2009 and 2017 and delivered their babies within one year of the NHSE were analyzed. Women were categorized by prepregnancy g-glutamyl transferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels. Multivariate logistic regression analysis was performed to obtain odds ratios (ORs) to estimate the relative risk of GDM+IT in relation to prepregnancy GGT, ALT, and AST levels, after adjusting variables. Approximately 0.65% women developed GDM+IT. Being in the highest quartile versus the lowest quartile of GGT and ALT levels were associated with increased risks of subsequent GDM+IT (adjusted odds ratio [aOR] 2.111 [95% CI 1.81–2.463] and aOR 1.838 [95% CI 1.577-2.143], respectively), after adjusting for age, smoking status, alcohol use, physical exercise, prepregnancy BMI, income level, metabolic status, and family history of diabetes. High GGT (≥ 19 U/L) and ALT (≥ 18 U/L) levels before pregnancy were significantly associated with increased odds of GDM+IT, regardless of BMI or metabolic syndrome. GGT ≥ 19 U/L before pregnancy was associated with significantly increased odds of GDM+IT (aOR 1.831 [95% CI 1.62, 2.07]) among women with a prepregnancy BMI < 25 kg/m2, and (aOR 1.887 [95% CI 1.671, 2.132]) among women without metabolic syndrome. Pregravid ALT or GGT level, but not AST level, predicted the subsequent risk of GDM+IT. Markers of liver fat accumulation, such as GGT or ALT level, are present years before pregnancy and may help to identify women at increased risk for subsequent GDM+IT, even in non-obese or metabolically healthy women.