Lin Lihua, Lin Juan, Yan Jianying, Wang Xiaomei
Department of Healthcare, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics, Gynaecology and Paediatrics, Fujian Medical University, Fuzhou, China.
Department of Obstetrics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics, Gynaecology and Paediatrics, Fujian Medical University, Fuzhou, China.
J Glob Health. 2025 Jun 20;15:04172. doi: 10.7189/jogh.15.04172.
Gestational diabetes mellitus (GDM) is a common complication during pregnancy, posing threats to both maternal and infant health. We aimed to investigate the association of remnant cholesterol (RC) and GDM during the first trimester of pregnancy through a prospective cohort study, and to explore the mediating effects of inflammation-related indicators.
We analysed data including 13 446 pregnant women and employed a generalised linear model to estimate the relative risk (RR) and 95% confidence intervals (CI) for the associations between RC level and GDM. We used the restricted cubic spline analyses to reflect the dose-response relationship. We made mediation analyses to explore the mediating effects of inflammation-related indicators on the relationship between RC level and risk of GDM.
The overall incidence of GDM was 22.3%, and this incidence increased across the RC quartiles, reaching 25.7% for the highest quartile of RC levels. There was a linear upward trend in the risk of GDM with increasing RC levels during the first trimester of pregnancy (P < 0.001 and for nonlinearity P = 0.124). Compared to the lowest RC quartile, higher RC quartiles were linked with an increased risk of GDM, with quartile two RR = 1.20 (95% CI = 1.07-1.36), quartile three RR = 1.24 (95% CI = 1.11-1.40), and quartile four RR = 1.48 (95% CI = 1.32-1.67), in the crude model. This positive association persisted even when total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels were within normal ranges, and it was consistent across groups stratified by maternal advanced age, occupation, gravidity, parity, pre-pregnancy body mass index, and hypertensive disorder of pregnancy. Moreover, inflammation-related indicators, including leukocytes and neutrophils, partially mediated these associations, accounting for 4.89% and 6.60% of the mediation proportion, respectively.
Higher serum RC levels in early pregnancy were positively associated with an increased risk of developing GDM. Leukocytes and neutrophils partially mediated these associations. RC may serve as an early predictor of GDM, and monitoring RC may help optimise GDM prevention.
妊娠期糖尿病（GDM）是孕期常见并发症，对母婴健康均构成威胁。我们旨在通过一项前瞻性队列研究，调查孕早期残余胆固醇（RC）与GDM之间的关联，并探讨炎症相关指标的中介作用。
我们分析了13446名孕妇的数据，并采用广义线性模型估计RC水平与GDM之间关联的相对风险（RR）和95%置信区间（CI）。我们使用受限立方样条分析来反映剂量反应关系。我们进行中介分析以探讨炎症相关指标对RC水平与GDM风险之间关系的中介作用。
GDM的总体发病率为22.3%，且该发病率在RC四分位数间呈上升趋势，RC水平最高四分位数组达到25.7%。孕早期，随着RC水平升高，GDM风险呈线性上升趋势（P<0.001，非线性检验P=0.124）。在粗模型中，与最低RC四分位数组相比，较高的RC四分位数组与GDM风险增加相关，第二四分位数组RR=1.20（95%CI=1.07-1.36），第三四分位数组RR=1.24（95%CI=1.11-1.40），第四四分位数组RR=1.48（95%CI=1.32-1.67）。即使总胆固醇、甘油三酯、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇水平在正常范围内，这种正相关仍然存在，并且在按母亲高龄、职业、孕次、产次、孕前体重指数和妊娠期高血压疾病分层的组中是一致的。此外，包括白细胞和中性粒细胞在内的炎症相关指标部分介导了这些关联，中介比例分别为4.89%和6.60%。
孕早期较高的血清RC水平与GDM发病风险增加呈正相关。白细胞和中性粒细胞部分介导了这些关联。RC可能作为GDM的早期预测指标，监测RC可能有助于优化GDM的预防。
