First-Trimester Triglyceride-Glucose Index and Risk of Pregnancy-Related Complications: A Prospective Birth Cohort Study in Southeast China

Abstract

Purpose: To evaluate the relationships of the triglyceride-glucose (TyG) index with pregnancy-related complications (PRCs) and to clarify the predictability of the TyG index for PRCs.

Patients and methods: Totally of 11,387 women with a singleton pregnancy were prospectively followed until after delivery. Maternal fasting lipids and glucose concentration were measured in the first trimester (11 weeks gestation on average). The TyG index was calculated as ln [triglyceride (mg/dL) × fasting plasma glucose (mg/dL)/2]. We used generalized linear models to calculate the relative risks and 95% confidence intervals. Receiver-operating characteristic curve analysis was employed to assess the ability of the TyG index to predict the risks of PRCs.

Results: Smooth spline reveals that the probability of gestational diabetes mellitus (GDM) is intensified with the increasing TyG index. Multivariate logistic regression adjusted for risk factors demonstrates a 1-unit and a 1-SD increment in the TyG index raises the risk of GDM by 3.63 and 1.57 times, respectively. Identically, the risk of GDM maximizes in the TyG quintile 5 (OR: 3.14; 95% CI: 2.55~3.85) relative to the lowest TyG index group. However, no association between TyG index and the risk of other PRCs was observed after full adjustment. The area under receiver operating characteristic curves is 0.647 (95% CI: 0.632-0.66) for GDM, and the optimal predictive cut-off is 8.55, with a specificity of 0.679 and sensitivity of 0.535.

Conclusion: The first-trimester TyG index is significantly associated with the risk of incident GDM, while the relationships between the TyG index and other PRCs need further exploration.

Keywords: first-trimester; gestational diabetes mellitus; pregnancy-related complications; singleton pregnancy; triglyceride-glucose index.

Figure 1

The risk of pregnancy-related complications with increasing triglyceride-glucose (TyG) index. The solid line represents adjusted probability and shadow parts 95% confidence intervals. Adjusted for race, pre-pregnancy BMI, maternal age, assisted reproduction, abortion history, gravidity, parity, gestational weight gain, delivery gestations, gestational week at the examination, systolic blood pressure, diastolic blood pressure, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, hemoglobin, uric acid, creatinine, alanine aminotransferase, and aspartate aminotransferase. (A), Gestational diabetes mellitus; (B), Gestational hypertension; (C), Preeclampsia; (D), Placental abruption; (E), Fetal distress; (F), Premature rupture of membranes.

Figure 2

Subgroup analysis of the association between triglyceride-glucose (TyG) index and risk of gestational diabetes mellitus (GDM). Models adjusted for race, pre-pregnancy BMI, maternal age, assisted reproduction, abortion history, gravidity, parity, gestational weight gain, delivery gestations, gestational week at the examination, systolic blood pressure, diastolic blood pressure, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, hemoglobin, uric acid, creatinine, alanine aminotransferase, and aspartate aminotransferase (not for adjusted variables stratified analysis).