Li Li, Zhou Yulai, Li Huan, Li Juan, Huang Lishi, Wu Weibin
The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, No. 910, Hengshan Rd., Shanghai, 200030, China.
Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China.
Diabetol Metab Syndr. 2025 Jan 6;16(1):311. doi: 10.1186/s13098-024-01550-2.
Triglyceride-glucose (TyG) index was suggested as a possible surrogate for insulin resistance and a predictor for cardiovascular diseases and diabetes in the non-pregnant population. However, the relationship between TyG index in early pregnancy and adverse pregnancy outcomes (APOs), and the contribution of pre-pregnancy body mass index (BMI) was still illusive.
A large retrospective cohort study involving 67,936 pregnant Chinese women between 2017 and 2022 was conducted. Data collection and laboratory tests were performed during the usual patient care. TyG index was calculated using ln [fasting plasma triglyceride (TG; mmol/L) × 88.5 × glucose (FPG; mmol/L) × 18.02/2]. Multivariable logistic regression models were applied to explore the relationship between TyG index and APOs. Interaction and stratification analyses were performed to assess the influence of pre-pregnancy BMI on the association. In addition, ROC curves were used to evaluate the potential predictive value of the TyG index and pre-pregnancy BMI.
Positive associations between maternal early pregnancy TyG index and APOs, including gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), large for gestational age (LGA) and preterm birth (PTB) were demonstrated (all P < 0.001). Besides, there was a significant interaction effect of maternal pre-pregnancy BMI and TyG on the risk of GDM, HDP and LGA (P < 0.05). Women of pre-pregnancy overweight/obesity (OWO) with TyG index in the fourth quartile were at an increased risk for GDM [adjusted OR (aOR) and 95% CI, 3.82 (3.14-4.64)], HDP [aOR 95% CI, 1.34 (1.10-1.64)], for LGA [aOR 95% CI, 1.78 (1.44-2.19)], and PTB [aOR 95% CI, 1.53 (1.11-2.09)], compared with OWO mothers with TyG in the lowest quartile. In addition, the combination of BMI and TyG enhanced predictive performance for APOs, particularly in women with normal plasma TG and FPG levels.
Dose-response relationships were identified between elevated maternal TyG index in early pregnancy and APOs. A combination of early pregnancy TyG index and pre-pregnancy BMI may provide predictive value for APOs, even in low-risk women. Thus, early screening of fasting blood lipids and glucose simultaneously may be useful and convenient for the early identification of APOs, both among OWO and low-risk normal-weight women.
甘油三酯-葡萄糖（TyG）指数被认为可能是胰岛素抵抗的替代指标，也是非妊娠人群心血管疾病和糖尿病的预测指标。然而，孕早期TyG指数与不良妊娠结局（APO）之间的关系以及孕前体重指数（BMI）的作用仍不明确。
进行了一项大型回顾性队列研究，纳入了2017年至2022年间67936名中国孕妇。在常规患者护理期间进行数据收集和实验室检查。TyG指数的计算方法为ln[空腹血浆甘油三酯（TG；mmol/L）×88.5×葡萄糖（FPG；mmol/L）×18.02/2]。应用多变量逻辑回归模型探讨TyG指数与APO之间的关系。进行交互作用和分层分析以评估孕前BMI对该关联的影响。此外，使用受试者工作特征（ROC）曲线评估TyG指数和孕前BMI的潜在预测价值。
证实了孕早期母亲TyG指数与APO之间存在正相关，包括妊娠期糖尿病（GDM）、妊娠高血压疾病（HDP）、大于胎龄儿（LGA）和早产（PTB）（所有P<0.001）。此外，母亲孕前BMI和TyG对GDM、HDP和LGA风险存在显著的交互作用（P<0.05）。与TyG处于最低四分位数的孕前超重/肥胖（OWO）母亲相比，TyG指数处于第四四分位数的OWO女性发生GDM的风险增加[调整优势比（aOR）及95%置信区间（CI），3.82（3.14 - 4.64）]，发生HDP的风险增加[aOR 95% CI，1.34（1.10 - 1.64）]，发生LGA的风险增加[aOR 95% CI，1.78（1.44 - 2.19）]，发生PTB的风险增加[aOR 95% CI，1.53（1.11 - 2.09）]。此外，BMI和TyG的联合提高了对APO的预测性能，尤其是在血浆TG和FPG水平正常的女性中。
确定了孕早期母亲TyG指数升高与APO之间的剂量反应关系。孕早期TyG指数和孕前BMI的联合可能为APO提供预测价值，即使在低风险女性中也是如此。因此，同时早期筛查空腹血脂和血糖可能对OWO和低风险正常体重女性早期识别APO有用且方便。
