{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T17:41:00Z","timestamp":1774460460284,"version":"3.50.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T00:00:00Z","timestamp":1655251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81901632"],"award-info":[{"award-number":["81901632"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82001576"],"award-info":[{"award-number":["82001576"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the effects of alanine transaminase (ALT) levels on the screening failure rates or \u201cno calls\u201d due to low fetal fraction (FF) to obtain a result in non-invasive prenatal screening (NIPS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>NIPS by sequencing and liver enzyme measurements were performed in 7,910 pregnancies at 12\u201326 weeks of gestation. Univariate and multivariable regression models were used to evaluate the significant predictors of screening failure rates among maternal characteristics and relevant laboratory parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 7,910 pregnancies that met the inclusion criteria, 134 (1.69%) had \u201cno calls.\u201d Multiple logistic regression analysis demonstrated that increased body mass index, ALT, prealbumin, albumin levels, and <jats:italic>in vitro<\/jats:italic> fertilization (IVF) conception rates were independently associated with screening failures. The test failure rate was higher (4.34 vs. 1.41%; <jats:italic>P<\/jats:italic> &amp;lt; 0.001) in IVF pregnancies relative to those with spontaneous conceptions. Meanwhile, the screening failure rates increased with increasing ALT levels from 1.05% at \u226410 U\/L to 3.73% at &amp;gt;40 U\/L. In particular, IVF pregnancies with an ALT level of &amp;gt;40 U\/L had a higher test failure rate (9.52%). Compared with that for an ALT level of \u226410 U\/L, the adjusted odds ratio of \u201cno calls\u201d for ALT levels of 10\u201320, 21\u201340, and &amp;gt;40 U\/L was 1.204 [95% confidence interval (CI), 0.709\u20132.045], 1.529 (95% CI, 0.865\u20132.702), and 2.764 (95% CI, 1.500\u20135.093) (<jats:italic>P<\/jats:italic><jats:sub><jats:italic>trend<\/jats:italic><\/jats:sub> &amp;lt; 0.001), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Increased ALT and IVF conceptions were associated with a higher screening failure rates in NIPS. Therefore, a feasible strategy to adjust these factors to reduce the probability of \u201cno calls\u201d due to low FF would be of great clinical significance.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.875588","type":"journal-article","created":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T05:33:43Z","timestamp":1655271223000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["The Effect of Elevated Alanine Transaminase on Non-invasive Prenatal Screening 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