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Background <p>The triglyceride-glucose (TyG) index, a surrogate indicator of insulin resistance, has been linked to adverse pregnancy outcomes. However, evidence among women with gestational diabetes mellitus (GDM) remains limited, especially concerning the relationship between the third-trimester TyG index and the risk of delivering a large for gestational age (LGA) infant. This study aimed to investigate this association and assess whether pre-pregnancy body mass index (BMI) modifies the relationship.</p> Methods <p>This retrospective multicenter cohort study included women with GDM who delivered singleton live births at four tertiary hospitals in Wuhan, China, between January 2022 and December 2023. Eligible participants had available third-trimester fasting triglyceride and fasting plasma glucose measurements for TyG index calculation. Multivariable logistic regression models were used to estimate odds ratios for LGA risk per 1-unit increase in the TyG index. Restricted cubic spline (RCS) analyses were performed to evaluate potential nonlinear associations, while stratified analyses examined differences across pre-pregnancy BMI categories. Crude LGA rates were calculated across TyG quartiles to illustrate absolute risk differences.</p> Results <p>Among 2,754 women with GDM, 283 (10.28%) delivered LGA infants. Each 1-unit increase in the third-trimester TyG index was associated with a significantly greater risk of LGA (adjusted OR 1.80, 95% CI 1.44–2.27). RCS analysis suggested a modest nonlinear association (<i>P</i> for nonlinearity = 0.046). The crude incidence of LGA increased from 7.6% in the lowest TyG quartile (Q1) to 16.3% in the highest quartile (Q4), corresponding to an absolute risk difference of 8.7 percentage points. The associations remained directionally consistent across BMI subgroups, with no significant interaction observed between TyG index and pre-pregnancy BMI (<i>P</i> for interaction &gt; 0.05).</p> Conclusions <p>An elevated third-trimester TyG index was independently associated with a higher risk of LGA in women with GDM. Although a potential nonlinear relationship was identified, the evidence supporting nonlinearity was limited. These findings support a statistical association rather than established clinical applicability. Further prospective studies are required to determine whether the TyG index can contribute to risk stratification or clinically meaningful risk assessment.</p>

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Restricted cubic spline analysis of the association between the third-trimester triglyceride-glucose index and neonatal birthweight in pregnant women with gestational diabetes mellitus: a multicenter cohort study

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  • 发表日期：

    2026年5月27日

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  • Tao Yu,
  • Kairong Lyu,
  • Yuanfei Wang,
  • Yamei Yang,
  • Li Gou,
  • Jing He

摘要

Background

The triglyceride-glucose (TyG) index, a surrogate indicator of insulin resistance, has been linked to adverse pregnancy outcomes. However, evidence among women with gestational diabetes mellitus (GDM) remains limited, especially concerning the relationship between the third-trimester TyG index and the risk of delivering a large for gestational age (LGA) infant. This study aimed to investigate this association and assess whether pre-pregnancy body mass index (BMI) modifies the relationship.

Methods

This retrospective multicenter cohort study included women with GDM who delivered singleton live births at four tertiary hospitals in Wuhan, China, between January 2022 and December 2023. Eligible participants had available third-trimester fasting triglyceride and fasting plasma glucose measurements for TyG index calculation. Multivariable logistic regression models were used to estimate odds ratios for LGA risk per 1-unit increase in the TyG index. Restricted cubic spline (RCS) analyses were performed to evaluate potential nonlinear associations, while stratified analyses examined differences across pre-pregnancy BMI categories. Crude LGA rates were calculated across TyG quartiles to illustrate absolute risk differences.

Results

Among 2,754 women with GDM, 283 (10.28%) delivered LGA infants. Each 1-unit increase in the third-trimester TyG index was associated with a significantly greater risk of LGA (adjusted OR 1.80, 95% CI 1.44–2.27). RCS analysis suggested a modest nonlinear association (P for nonlinearity = 0.046). The crude incidence of LGA increased from 7.6% in the lowest TyG quartile (Q1) to 16.3% in the highest quartile (Q4), corresponding to an absolute risk difference of 8.7 percentage points. The associations remained directionally consistent across BMI subgroups, with no significant interaction observed between TyG index and pre-pregnancy BMI (P for interaction > 0.05).

Conclusions

An elevated third-trimester TyG index was independently associated with a higher risk of LGA in women with GDM. Although a potential nonlinear relationship was identified, the evidence supporting nonlinearity was limited. These findings support a statistical association rather than established clinical applicability. Further prospective studies are required to determine whether the TyG index can contribute to risk stratification or clinically meaningful risk assessment.