{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:54:45Z","timestamp":1789480485564,"version":"build-2803163510"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The aspartate aminotransferase to alanine aminotransferase (AST\/ALT) ratio is associated with insulin resistance (IR) and diabetes mellitus, but its association with gestational diabetes mellitus (GDM) has been less well-studied.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Our study aimed to investigate whether the AST\/ALT ratio is associated with GDM in a population of pregnant Korean women.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The study was a secondary analysis of a prospective cohort study. It included 623 pregnant women who were at 10\u201314 weeks of gestation between November 2014 and September 2016. We downloaded and analyzed the data in October 2024. A total of 575 singleton pregnant women were included after excluding missing variables. All participants were followed up until the birth of their children. AST\/ALT ratio was obtained by dividing AST by ALT. AST\/ALT ratio was used as a continuous variable, and a quartile categorical variable was used for analysis. Logistic regression models were used to estimate the relationship between AST\/ALT ratio and GDM. Subgroup and sensitivity analyses were conducted to explore the stability of this relationship. Restricted cubic spline (RCS) curve fitting was employed to investigate potential non-linear associations.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Pregnant women were stratified into quartiles based on their AST\/ALT ratios, with the following cutoff values: Q1 (&lt;1.167), Q2 (1.167\u20131.499), Q3 (1.5\u20131.818), and Q4 (&gt;1.818). The overall mean AST\/ALT ratio across all participants was 1.6\u2009\u00b1\u20091.0. After adjusting for confounders, the AST\/ALT ratio was negatively associated with GDM (OR=0.45, 95% CI: 0.2\u20130.99), with results confirmed by sensitivity and subgroup analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This study demonstrated that a lower AST\/ALT ratio in early pregnancy was independently and negatively associated with the risk of GDM. The AST\/ALT ratio may serve as a potential early biomarker to identify pregnant women at higher risk of GDM, contributing to targeted preventive strategies.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0331484","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T17:53:32Z","timestamp":1756490012000},"page":"e0331484","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association between AST\/ALT ratio and the risk of gestational diabetes mellitus in Korean pregnant 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