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Early maternal circulating alkaline phosphatase with subsequent gestational diabetes mellitus and glucose regulation: a prospective cohort study in China

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Abstract

Purpose

Emerging clinical evidence has implied that alkaline phosphatase (ALP) may contribute to gestational diabetes mellitus (GDM). However, there were no studies to reveal the independent and prospective associations between ALP and GDM. Our aim was to explore the independent and prospective associations between early maternal ALP level and GDM risk and glucose regulation.

Methods

In a prospective cohort study with 2073 singleton mothers at four maternity units in China, maternal serum ALP levels were measured before 20 gestational weeks. Using logistic regression, we analyzed the relationship between maternal ALP level and risk of GDM. We further explored the relationships of ALP level to fasting blood glucose (FBG), 1-h and 2-h post-load blood glucose (1-h, 2-h PBG) with multiple linear regression. Finally, we analyzed the association between maternal ALP level and isolated impaired fasting glucose (i-IFG) and isolated impaired glucose tolerance (i-IGT) risk.

Results

The maximum value of maternal ALP level was 90 U/L, within the normal range. After adjustment for confounding factors, the odds ratio (ORs) of GDM increased linearly with ALP level (p for overall association = 0.002, p for nonlinear association = 0.799), with the OR comparing the highest versus lowest quartile of 2.47 (95% CI 1.47, 4.15). Moreover, each additional of 10 U/L ALP level was associated with a 2% higher FBG (p = 0.043) and a 12% higher 1-h PBG (p = 0.004). Higher ALP level also increased the risk of i-IFG (OR 3.73, 95% CI 1.17–11.86) and i-IGT (OR 2.03, 95% CI 1.07–3.84).

Conclusions

Even within the upper limit of normal, higher early maternal ALP level could increase the risk of GDM. Moreover, both FBG and PBG were increased with early maternal ALP.

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Acknowledgements

The authors gratefully acknowledge the cooperation of the pregnant women who took part in this study. We also thank the staff at the maternity clinics of Hubei Maternal and Child Health Hospital and The Central Hospital of Wuhan for their considerable assistance with many aspects of this study. We are sincerely grateful to everyone in Tongji Maternal and Child Health Cohort Study Group.

Author contributions

N.Y., X.Y., and L.H. designed the study; T.X., C.Z., G.S., X.Z., R.C., Q.L., Y.W., Q.G., L.H., X.H., and M.X. researched the data; T.X. drafted the paper; L.H. and N.Y. reviewed/edited the paper and contributed to discussion. N.Y. was the guarantor of this work.

Funding

This work was supported by the National Program on Basic Research Project of China (No. 2013FY114200) and China Postdoctoral Science Foundation (No. 2018M632877).

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Authors and Affiliations

  1. Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety and the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430070, People’s Republic of China

    Ting Xiong, Chunrong Zhong, Xuezhen Zhou, Renjuan Chen, Qian Li, Yuanjue Wu, Qin Gao, Li Huang, Xuefeng Yang, Liping Hao & Nianhong Yang

  2. Hubei Maternal and Child Health Hospital, Wuhan, Hubei, 430070, People’s Republic of China

    Guoqiang Sun, Xingwen Hu & Mei Xiao

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  1. Ting Xiong
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Corresponding authors

Correspondence to Liping Hao or Nianhong Yang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Review Committee of Tongji Medical College, Huazhong University of Science and Technology (No. 201302).

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Informed consent was obtained from all individual participants included in the study.

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These authors contributed equally: Liping Hao, Nianhong Yang

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Xiong, T., Zhong, C., Sun, G. et al. Early maternal circulating alkaline phosphatase with subsequent gestational diabetes mellitus and glucose regulation: a prospective cohort study in China. Endocrine 65, 295–303 (2019). https://doi.org/10.1007/s12020-019-01954-5

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