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

Haibo Li,1,* Chong Miao,2,* Wenjuan Liu,1,3 Haiyan Gao,1,4 Wei Li,1,4 Zhengqin Wu,1,4 Hua Cao,1,5 Yibing Zhu1 1Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China; 2Department of Information, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China; 3Division of Birth Cohort Study, Fujian Children’s Hospital, Fuzhou, People’s Republic of China; 4Division of Birth Cohort Study, Fujian Obstetrics and Gynecology Hospital, Fuzhou, People’s Republic of China; 5Fujian Key Laboratory of Women and Children’s Critical Disease Research, Fuzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yibing Zhu, Division of Birth Cohort Study, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People’s Republic of China, Tel +86-0591-87560934, Fax +86-0591-87505886, Email zybfmc@163.com Hua Cao, Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, People’s Republic of China, Tel +86-0591-87562990, Fax +86-0591-87505886, Email caohua69@fjmu.edu.cnPurpose: 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, triglyceride-glucose index, pregnancy-related complications, gestational diabetes mellitus, singleton pregnancy