The association of plasma levels of liver enzymes and risk of gestational diabetes mellitus: a systematic review and dose-response meta-analysis of observational studies

Acta Diabetol. 2020 Jun;57(6):635-644. doi: 10.1007/s00592-019-01458-8. Epub 2019 Nov 28.

Abstract

Aims: Relationship between liver enzymes such as gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate transaminase (AST) and alkaline phosphatase and risk of gestational diabetes mellitus (GDM) is a controversial issue. The aim of this systematic review and dose-response meta-analysis was to investigate the association between liver enzymes and risk of GDM in observational studies.

Methods: A comprehensive systematic literature search was conducted in MEDLINE/PubMed, SCOPUS and Web of Science databases up to September 2019. Combined odds ratios (ORs) with 95% confidence intervals (CIs) were evaluated by DerSimonian and Laird random-effects models. Dose-response analyses of these relationships were also carried out.

Results: Eight studies with 25,451 participants containing 2549 cases were included in this study. Pooled results showed a significant association between GGT levels and risk of GDM (OR 2.10, 95% CI 1.14-3.86, I2 84%). In addition, random-effects model indicated a dramatic and direct significant association between GGT and risk of GDM in nonlinear (p < 0.001) and linear (p < 0.001) dose-response analysis. Associations between ALT and AST with risk of GDM were found to be non-significant (OR 1.32, 95% CI 0.91-1.90, I2 65% and OR 0.76, 95% CI 0.52-1.10, I2 16%, respectively).

Conclusion: This systematic review and dose-response meta-analysis highlights GGT as a significant and robust predictor of the incidence of GDM in pregnant women.

Keywords: Gamma-glutamyl transferase; Gestational diabetes mellitus; Liver enzymes.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Alanine Transaminase / blood
  • Alkaline Phosphatase / blood
  • Aspartate Aminotransferases / blood
  • Blood Chemical Analysis / statistics & numerical data
  • Diabetes, Gestational / blood*
  • Diabetes, Gestational / epidemiology
  • Diabetes, Gestational / etiology*
  • Female
  • Humans
  • Incidence
  • Liver / enzymology*
  • Liver Function Tests
  • Observational Studies as Topic / statistics & numerical data*
  • Pregnancy
  • Prenatal Diagnosis / statistics & numerical data
  • Risk Factors
  • gamma-Glutamyltransferase / blood

Substances

  • gamma-Glutamyltransferase
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • Alkaline Phosphatase