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

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.