High ALT levels and risk of gestational diabetes and preeclampsia


Dr Veena Aggarwal, Consultant Womens’ Health, CMD and Editor-in-Chief, IJCP Group & Medtalks Trustee, Dr KK’s Heart Care Foundation of India    11 December 2022

Women with high alanine aminotransferase (ALT) levels in early part of pregnancy are at least thrice more likely to develop gestational diabetes and preeclampsia later on in pregnancy, suggests a recent study published in the Journal of Korean Medical Science.1


A total of 2322 pregnant women visiting a Womens Healthcare Center in Seoul, South Korea were included in this retrospective study to determine if raised ALT levels in early pregnancy had a correlation with development of gestational diabetes or preeclampsia during the third trimester of pregnancy. Women with singleton pregnancies who had been screened for gestational diabetes and had ALT levels measured antenatally at 4–20 weeks of gestation were included in the study. Based on the levels of ALT, the participants were categorized into two groups: one with normal ALT levels (≤ 95th percentile) and the second with raised ALT levels (> 95th percentile).


Compared to women with normal ALT levels, the risk of gestational diabetes later on in pregnancy, as per WHO criteria using the 50 g oral glucose challenge test and 75 g glucose challenge test, was increased among women with high ALT levels; 2.1% vs 6.5%, respectively. Likewise, women with raised ALT levels also were more likely to develop pre-eclampsia; 1% vs 4.1%. The association between the elevated risk of gestational diabetes and preeclampsia and high ALT levels remained significant even after adjusting for variables such as age of the mother and body mass index (BMI) before becoming pregnant.


According to the authors, this study has for the first time demonstrated the interrelationship between high ALT levels in early pregnancy and the risk of gestational diabetes and preeclampsia later on. Hence, women who have high ALT levels during early pregnancy, which cannot be otherwise explained, should be screened for gestational diabetes. Blood glucose levels and blood pressure including proteinuria should be closely monitored all through the pregnancy for timely detection of gestational diabetes and preeclampsia, which may develop during late pregnancy.




  1. Lee SM, et al. Elevated alanine aminotransferase in early pregnancy and subsequent development of gestational diabetes and preeclampsia. J Korean Med Sci. 2020 Jul 6;35(26):e198. doi: 10.3346/jkms.2020.35.e198.

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