孕早期谷丙转氨酶与发生巨大儿和大于胎龄儿关系

目的 探讨孕早期谷丙转氨酶（ALT）水平与发生巨大儿或大于胎龄儿（LGA）的相关性。方法 利用天津市妇幼卫生信息系统记录的2009-2010年天津市内6区和滨海新区孕早期接受第一次产检的26 956名单胎妊娠孕妇的孕期基本信息、检查结果和分娩信息，通过logistic回归分析孕早期ALT水平与巨大儿或LGA发生的关联。结果 26 956名孕妇孕早期ALT中位数水平为15.2 U/L（四分位数界值：11.0~22.0 U/L），ALT≥40 U/L占5.1%。分娩巨大儿者占10.1%，LGA占17.7%。多因素logistic回归结果显示，相对于ALT水平<40 U/L，ALT水平≥40 U/L组孕妇更容易分娩出巨大儿（OR=1.192，95%CI=1.008~1.410）和LGA（OR=1.160，95%CI=1.012~1.330）。以ALT<40 U/L且非肥胖为参考组，ALT<40 U/L且肥胖（OR=3.011，95%CI=2.593~3.496）、ALT≥40 U/L且非肥胖（OR=1.320，95%CI=1.097~1.589）、ALT≥40 U/L且肥胖（OR=3.837，95%CI=2.675~5.502）均与巨大儿发生有关联。同样，ALT<40 U/L且肥胖（OR=2.781，95%CI=2.458~3.147）、ALT≥40 U/L且非肥胖（OR=1.238，95%CI=1.066~1.437）、ALT≥40 U/L且肥胖（OR=3.766，95%CI=2.757~5.144）均与LGA发生有关联。结论 孕早期ALT水平单独或联合母亲肥胖均与巨大儿或LGA的发生相关。

Association of maternal serum alanine aminotransferase in first trimester with risk of macrosomia and large for gestational age infant

Objective To examine the association between maternal serum alanine aminotransferase (ALT) in the first trimester and the risk of macrosomia and large for gestational age(LGA)infant. Methods We used Tianjin Municipal Maternal and Child Health Information System and collected information on basic characteristics, antenatal care, detection result of ALT, and delivery outcome of 26 956 pregnant women with single-pregnancy who were registered for pregnancy and attended their first antenatal care within the first 12 weeks of gestation in 6 central urban districts and Binhai New District.Multivariate logistic regression was performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs).To examine the joint effect of serum ALT and maternal obesity on the risks of macrosomia and LGA infant, the women were divided into four groups:non-obese group with ALT<40 U/L, obese and ALT<40 U/L, non-obese group with ALT≥40 U/L, and obese and ALT≥40 U/L. Results The median serum ALT at first antenatal care visit was 15.2 U/L (interquartile range:11.0-22.0 U/L) and 5.1% of the women showed the level of ALT≥40 U/L.Of all the newborns, 10.1% were macrosomia and 14.1% were LGA infants.The results of multivariate logistic regression demonstrated that the women with the ALT of ≥40 U/L were more likely to give birth to macrosomia (OR[95% CI]:1.192[1.008-1.410]) and LGA infant (1.160[1.012-1.330]) compared to those with the ALT of <40 U/L;the results also revealed that compared to the non-obese women with the ALT of <40 U/L, the women with obesity and/or increased serum ALT were at higher risk of giving birth to macrosomia (OR[95% CI]for the obese with ALT <40 U/L:3.011[2.593-3.496], for the non-obese with ALT ≥40 U/L:1.320[1.097-1.589], and for the obese with ALT ≥40 U/L:3.837[2.675-5.502]) and to LGA infant (OR[95% CI]for the obese with ALT <40 U/L:2.781[2.458-3.147], for the non-obese with ALT ≥40 U/L:1.238[1.066-1.437], and for the obese with ALT ≥40 U/L:3.766[2.757-5.144]). Conclusion Elevated ALT in first trimester alone or combined with maternal obesity correlate with the increased risk of giving birth to macrosomia and large for gestational age infant.