Feng Lu, Yingjie Chen
GDM occurred in 1,187 pregnancies (21.1%) and HDP in 275 pregnancies (4.9%). Compared with Q1, Q4 was associated with higher risk of GDM (adjusted RR, 1.54; 95% CI, 1.34 to 1.77) and HDP (adjusted RR, 1.89; 95% CI, 1.33 to 2.67). Each 10 μmol/L increase in uric acid was associated with GDM (adjusted RR, 1.03; 95% CI, 1.02 to 1.04) and HDP (adjusted RR, 1.04; 95% CI, 1.02 to 1.06). Spline analyses showed modest evidence of nonlinearity for GDM but not for HDP.
BACKGROUND: Gestational diabetes mellitus (GDM) is a common pregnancy complication, yet current diagnosis at 24-28 weeks may occur after metabolic changes have already begun. The atherogenic index of plasma (AIP, log₁₀[TG/HDL-C]) has shown promise for early GDM risk stratification, but it does not incorporate obesity-related parameters. We evaluated whether first-trimester AIP and its modified indices, AIP-BMI and AIP-WC, are associated with subsequent GDM and compared their predictive performance.
METHODS: This secondary analysis of a prospective Korean cohort included 581 women with singleton pregnancies. AIP, AIP-BMI (AIP × BMI), and AIP-WC (AIP × waist circumference) were calculated using fasting measurements obtained at 10-14 weeks of gestation; BMI and waist circumference were algebraically reconstructed from the full-precision components of the hepatic steatosis index and fatty liver index because contemporaneous direct measurements were unavailable in the public dataset. GDM was diagnosed at 24-28 weeks using the two-step ACOG approach. Multivariable logistic regression, restricted cubic spline, sensitivity, subgroup, and receiver operating characteristic analyses were performed.
RESULTS: GDM occurred in 36 women (6.2%). In the fully adjusted model, AIP (per 0.1-unit increase: OR 1.66, 95% CI 1.36-2.03; Q3 vs Q1: OR 7.86, 95% CI 1.93-32.08), AIP-BMI (OR 1.20, 95% CI 1.11-1.31), and AIP-WC (OR 1.05, 95% CI 1.03-1.08) were associated with GDM (all P < 0.001). Overall associations were significant in restricted cubic spline analyses, without evidence of nonlinearity. Among individual indices, AIP-BMI had the largest apparent AUC (83.05%, sensitivity 81%, specificity 80%), followed by AIP-WC (81.32%) and AIP (78.66%). The AIP + AIP-BMI model had the largest apparent AUC among evaluated models (84.19%, sensitivity 81%, specificity 81%). Results remained broadly consistent in sensitivity analyses excluding participants with NAFLD, whereas subgroup analyses were underpowered to detect interactions.
CONCLUSION: First-trimester AIP, AIP-BMI, and AIP-WC were associated with subsequent GDM, and AIP-BMI showed higher apparent discrimination than AIP alone in this sample. These findings require confirmation in larger cohorts with directly measured anthropometry and appropriate internal and external validation.