<b>The Associations of Maternal Liver Biomarkers in Early Pregnancy with the Risk of Gestational Diabetes Mellitus</b><b>: A Prospective Cohort Study</b>

Zhoushan Pregnant Women Cohort (ZPWC) is an ongoing prospective cohort that recruits pregnant women over 18 years old at 8-14 weeks of gestation. All data in this study was obtained from a structured questionnaire and a comprehensive Electronic Medical Record System (EMRS) in Zhoushan Maternal and Child Care Hospital, Zhejiang. The work was conducted according to the Declaration of Helsinki and has been approved by the Institutional Review Board of Zhoushan Maternal and Child Health Care Hospital (Ethical Approval Code: 2011-05). Informed consent was obtained from all subjects involved in this study.We obtained the liver function tests of pregnant women from the biochemical examination database. Venous blood was collected at 8-14 gestational weeks, and serum liver enzymes including ALT, AST, GGT, and ALP were quickly measured by a Hitachi 7600 automatic biochemical analyzer. Blood lipid biomarkers including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were also extracted from biochemical databases. Pregnant women without apparent diabetes routinely undergo a 75g OGTT after an overnight fast at 24 to 28 weeks of gestation.