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Background <p>Gestational diabetes mellitus (GDM) is associated with substantial maternal and neonatal morbidity. Early identification of women at risk remains a clinical priority. This study aimed to develop and evaluate a simple first-trimester risk prediction model for subsequent GDM using fasting triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and glucose-derived indices (TyG, TG/HDL-C, and Lipid-IR).</p> Methods <p>This single-center retrospective cohort included 679 pregnant women with first-trimester fasting lipid and glucose measurements. Of these, 342 developed GDM (diagnosed at 24–28 weeks using a two-step approach and Carpenter–Coustan criteria), and 337 remained normoglycemic. Baseline demographic, anthropometric, laboratory, and obstetric/neonatal variables were compared. TyG was calculated as ln[(fasting triglycerides (mg/dL) × fasting glucose (mg/dL)) / 2], TG/HDL-C as TG (mg/dL) divided by HDL-C (mg/dL), and Lipid-IR as ln(2 × TG (mg/dL) + total cholesterol (mg/dL)). Independent predictors were identified through multivariable logistic regression. Receiver operating characteristic (ROC) analysis evaluated discriminative ability and optimal cut-off points using Youden’s J statistic.</p> Results <p>Compared with controls, women who developed GDM were older and had higher pre-pregnancy and current body weights, body mass index (BMI), and waist circumference (all <i>p</i> ≤ 0.003). They also exhibited higher fasting glucose, HbA1c, insulin, TG, total cholesterol, and liver enzyme levels, and lower HDL-C concentrations (all <i>p</i> ≤ 0.03). Cesarean delivery was more frequent among women with GDM (58% vs. 32%; <i>p</i> = 0.001), with higher birth weights and lower 5-minute Apgar scores. In multivariable models, Lipid-IR (OR 1.85), TG/HDL-C (OR 2.12), and TyG (OR 1.63) were independently associated with GDM (all <i>p</i> &lt; 0.001). Discrimination was strong, with AUCs of 0.88 for TyG, 0.82 for Lipid-IR, and 0.79 for TG/HDL-C; combining all three indices increased the AUC to 0.92 (sensitivity 89%, specificity 85%).</p> Conclusion <p>In this single-center retrospective cohort, first-trimester lipid–glucose indices—particularly the TyG index were strongly associated with subsequent GDM, and a combined model showed good discrimination for risk stratification. External validation and assessment of clinical impact are required before routine clinical implementation.</p> Clinical trial number <p>Not applicable.</p> Clinical implication <p>Simple lipid–glucose–derived indices can be incorporated into early prenatal screening to identify women at high risk for GDM, enabling early risk stratification and intensified follow-up prior to OGTT, rather than treatment initiation.</p>

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First-trimester lipid- and glucose-derived indices for predicting gestational diabetes mellitus: development of a combined model in a single-center retrospective cohort

  • 期刊论文

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  • 发表日期：

    2026年2月11日

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  • Mücahit Furkan Balcı,
  • Celal Akdemir,
  • Fatih Yıldırım,
  • Suna Yıldırım Karaca,
  • İbrahim Karaca

摘要

Background

Gestational diabetes mellitus (GDM) is associated with substantial maternal and neonatal morbidity. Early identification of women at risk remains a clinical priority. This study aimed to develop and evaluate a simple first-trimester risk prediction model for subsequent GDM using fasting triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and glucose-derived indices (TyG, TG/HDL-C, and Lipid-IR).

Methods

This single-center retrospective cohort included 679 pregnant women with first-trimester fasting lipid and glucose measurements. Of these, 342 developed GDM (diagnosed at 24–28 weeks using a two-step approach and Carpenter–Coustan criteria), and 337 remained normoglycemic. Baseline demographic, anthropometric, laboratory, and obstetric/neonatal variables were compared. TyG was calculated as ln[(fasting triglycerides (mg/dL) × fasting glucose (mg/dL)) / 2], TG/HDL-C as TG (mg/dL) divided by HDL-C (mg/dL), and Lipid-IR as ln(2 × TG (mg/dL) + total cholesterol (mg/dL)). Independent predictors were identified through multivariable logistic regression. Receiver operating characteristic (ROC) analysis evaluated discriminative ability and optimal cut-off points using Youden’s J statistic.

Results

Compared with controls, women who developed GDM were older and had higher pre-pregnancy and current body weights, body mass index (BMI), and waist circumference (all p ≤ 0.003). They also exhibited higher fasting glucose, HbA1c, insulin, TG, total cholesterol, and liver enzyme levels, and lower HDL-C concentrations (all p ≤ 0.03). Cesarean delivery was more frequent among women with GDM (58% vs. 32%; p = 0.001), with higher birth weights and lower 5-minute Apgar scores. In multivariable models, Lipid-IR (OR 1.85), TG/HDL-C (OR 2.12), and TyG (OR 1.63) were independently associated with GDM (all p < 0.001). Discrimination was strong, with AUCs of 0.88 for TyG, 0.82 for Lipid-IR, and 0.79 for TG/HDL-C; combining all three indices increased the AUC to 0.92 (sensitivity 89%, specificity 85%).

Conclusion

In this single-center retrospective cohort, first-trimester lipid–glucose indices—particularly the TyG index were strongly associated with subsequent GDM, and a combined model showed good discrimination for risk stratification. External validation and assessment of clinical impact are required before routine clinical implementation.

Clinical trial number

Not applicable.

Clinical implication

Simple lipid–glucose–derived indices can be incorporated into early prenatal screening to identify women at high risk for GDM, enabling early risk stratification and intensified follow-up prior to OGTT, rather than treatment initiation.