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Background <p>Understanding maternal liver function in human immunodeficiency virus (HIV)-positive pregnancies is essential for improving maternal and infant health and preventing mother-to-child transmission. HIV-positive pregnant women are at risk of adverse pregnancy outcomes (APO). While liver damage in HIV-infected individuals is well known, the impact of maternal circulating liver function markers on APOs remains underexplored. This study investigated the association between liver function markers and APO in HIV-infected pregnant women in China.</p> Methods <p>This retrospective cohort study analyzed data from the China prevention of mother-to-child transmission program (2011–2024), assessing maternal alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil) levels during pregnancy. Multivariate-adjusted binary logistic regression was conducted to estimate odds ratios (OR) and 95% confidence intervals (CI). The main outcome measures were low birth weight or preterm birth (LBW/PTB), small for gestational age (SGA), and overall APO.</p> Results <p>1096 HIV-infected pregnant women were included in this study. We recorded 330 cases of APO, including LBW/PTB (<i>n</i> = 177) and SGA (<i>n</i> = 199). A significant U-shaped association was found between maternal ALT levels and overall APO and LBW/PTB risk (<i>p</i> for non-linearity &lt; 0.001), with the higher risks at both low (&lt; 10 U/L) and high (≥ 30 U/L) levels. Compared to ALT at 20–29 U/L, the ORs (95% CI) of overall APO were 1.91 (1.16–3.13) for ALT &lt; 10 U/L and 2.35 (1.27–4.35) for ALT ≥ 30 U/L. Elevated AST concentrations were linked to higher risks of overall APO, LBW/PTB and SGA. Moreover, a positive correlation was observed between TBil levels and LBW/PTB. Notably, the association between maternal liver function markers (ALT, AST) and APO was trimester-dependent, emerging significantly only during the third trimester.</p> Conclusions <p>Our findings suggest that maternal circulating liver function markers are important predictors of APO in HIV-infected pregnant women in China. Monitoring liver function markers may aid early risk assessment and interventions to improve outcomes in HIV-infected pregnancies.</p>

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Maternal liver function and adverse pregnancy outcomes in Chinese women with HIV: a cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月21日

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  • E Wu,
  • Jun-Tao Ni,
  • Lijun Xu,
  • Yin-wei Chen,
  • Xiao-Hui Zhang

摘要

Background

Understanding maternal liver function in human immunodeficiency virus (HIV)-positive pregnancies is essential for improving maternal and infant health and preventing mother-to-child transmission. HIV-positive pregnant women are at risk of adverse pregnancy outcomes (APO). While liver damage in HIV-infected individuals is well known, the impact of maternal circulating liver function markers on APOs remains underexplored. This study investigated the association between liver function markers and APO in HIV-infected pregnant women in China.

Methods

This retrospective cohort study analyzed data from the China prevention of mother-to-child transmission program (2011–2024), assessing maternal alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil) levels during pregnancy. Multivariate-adjusted binary logistic regression was conducted to estimate odds ratios (OR) and 95% confidence intervals (CI). The main outcome measures were low birth weight or preterm birth (LBW/PTB), small for gestational age (SGA), and overall APO.

Results

1096 HIV-infected pregnant women were included in this study. We recorded 330 cases of APO, including LBW/PTB (n = 177) and SGA (n = 199). A significant U-shaped association was found between maternal ALT levels and overall APO and LBW/PTB risk (p for non-linearity < 0.001), with the higher risks at both low (< 10 U/L) and high (≥ 30 U/L) levels. Compared to ALT at 20–29 U/L, the ORs (95% CI) of overall APO were 1.91 (1.16–3.13) for ALT < 10 U/L and 2.35 (1.27–4.35) for ALT ≥ 30 U/L. Elevated AST concentrations were linked to higher risks of overall APO, LBW/PTB and SGA. Moreover, a positive correlation was observed between TBil levels and LBW/PTB. Notably, the association between maternal liver function markers (ALT, AST) and APO was trimester-dependent, emerging significantly only during the third trimester.

Conclusions

Our findings suggest that maternal circulating liver function markers are important predictors of APO in HIV-infected pregnant women in China. Monitoring liver function markers may aid early risk assessment and interventions to improve outcomes in HIV-infected pregnancies.