Zhang Lirui, Yan Xin, Zheng Wei, Yuan Xianxian, Yang Ruihua, Huang Junhua, Pang Huiyuan, Lu Yixuan, Zhang Yujie, Chen Tengda, Wang Ziyu, Li Guanghui
Division of Endocrinology and Metabolism, Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.
Beijing Maternal and Child Health Care Hospital, No. 251, Yaojiayuan Road, Chaoyang District, Beijing, 100026, China.
J Endocrinol Invest. 2025 Jul 12. doi: 10.1007/s40618-025-02630-4.
Insulin resistance (IR) is a significant factor in gestational diabetes mellitus (GDM) development. The triglyceride-glucose (TyG) index, triglyceride-glucose body mass index (TyG-BMI), atherogenic index of plasma (AIP), and metabolic score for insulin resistance (METS-IR) are simple and reliable surrogates for assessing IR, but their predictive potential for GDM remains unexplored.
Data from 46,992 singleton pregnancies delivered at Beijing Obstetrics and Gynecology Hospital between 2018 and 2022 were prospectively collected. IR indices were calculated using first-trimester blood lipid and glucose measurements. Participants were classified into GDM and non-GDM groups based on oral glucose tolerance test (OGTT) results at 24-28 weeks. Logistic regression and restricted cubic spline analyses assessed the associations between IR indices and GDM, with subgroup analyses to assess results robustness. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the predictive performance of the IR indices for GDM.
Among the participants, 6,045 were diagnosed with GDM and 40,947 were not. Binary logistic regression showed a significant positive association between first-trimester IR indices and GDM (p < 0.001). AUCs for GDM prediction were 0.646 for TyG, 0.651 for TyG-BMI, 0.629 for AIP, and 0.641 for METS-IR. A basic model with maternal demographics achieved an AUC of 0.666. Adding TyG-BMI improved the AUC to 0.693.
All four surrogate IR indices measured in the first trimester were positively associated with GDM, with TyG-BMI emerging as the strongest predictor.
胰岛素抵抗（IR）是妊娠期糖尿病（GDM）发生发展的一个重要因素。甘油三酯-葡萄糖（TyG）指数、甘油三酯-葡萄糖体重指数（TyG-BMI）、血浆致动脉粥样硬化指数（AIP）和胰岛素抵抗代谢评分（METS-IR）是评估IR的简单可靠替代指标，但其对GDM的预测潜力仍未得到探索。
前瞻性收集了2018年至2022年在北京妇产医院分娩的46992例单胎妊娠的数据。使用孕早期血脂和血糖测量值计算IR指数。根据24-28周时的口服葡萄糖耐量试验（OGTT）结果，将参与者分为GDM组和非GDM组。采用逻辑回归和受限立方样条分析评估IR指数与GDM之间的关联，并进行亚组分析以评估结果的稳健性。采用受试者工作特征（ROC）曲线下面积（AUC）评估IR指数对GDM的预测性能。
在参与者中，6045例被诊断为GDM，40947例未被诊断为GDM。二元逻辑回归显示，孕早期IR指数与GDM之间存在显著正相关（p < 0.001）。TyG对GDM预测的AUC为0.646，TyG-BMI为0.651，AIP为0.629，METS-IR为0.641。包含孕妇人口统计学特征的基本模型的AUC为0.666。加入TyG-BMI后，AUC提高到0.693。
孕早期测量的所有四个IR替代指标均与GDM呈正相关，其中TyG-BMI是最强的预测指标。
