Lipid Ratios Linked to Higher Gestational Diabetes Risk: Study on 6,600 Pregnant Women Reveals
China: A new study, published in Diabetes, Metabolic Syndrome and Obesity, has shed light on the potential role of specific lipid markers in identifying women at a higher risk for gestational diabetes mellitus (GDM). Conducted by Dr. Yao Cheng and colleagues from the Maternal and Child Health Hospital of Hubei Province, China, the research highlights the predictive value of atherogenic indices and remnant cholesterol in anticipating GDM development.
Drawing data from over 6,600 pregnant women, including 2,054 diagnosed with GDM, the researchers analyzed routine lipid parameters such as triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Using these values, they calculated atherogenic indices—specifically TG/HDL-C, TC/HDL-C, and LDL-C/HDL-C ratios—as well as remnant cholesterol levels to determine their relationship with the risk of GDM.
The study revealed the following findings:
- Women in the highest quartile of atherogenic indices had a significantly higher likelihood of developing gestational diabetes mellitus compared to those in the lowest quartile.
- A 66% increased risk of GDM was observed among women with elevated TG/HDL-C ratios.
- Those with higher TC/HDL-C and LDL-C/HDL-C ratios had a 47% increased risk of developing GDM.
- Elevated remnant cholesterol levels were associated with a 39% higher risk of GDM.
- Logistic regression, decision curve analysis (DCA), and restricted cubic spline (RCS) analysis confirmed the strength of these associations.
- RCS analysis revealed a nonlinear relationship between lipid measures and the risk of GDM.
- The study identified clinical threshold values for elevated GDM risk: TG/HDL-C = 1.64, TC/HDL-C = 3.47, LDL-C/HDL-C = 1.54, and remnant cholesterol = 0.65.
The authors highlighted the clinical utility of these findings, emphasizing that routine lipid testing during early pregnancy could serve as a simple and cost-effective tool for GDM risk screening. Early identification of at-risk individuals could allow for timely lifestyle or medical interventions to mitigate complications associated with gestational diabetes.
However, the study also acknowledged some limitations. Since it was conducted using data from a single center in China, its generalizability to other populations may be limited. Furthermore, the cross-sectional nature of the analysis does not establish causality. Other important factors like insulin resistance, gestational weight gain, liver function, lifestyle habits, and socioeconomic status were not included due to data constraints. Additionally, lipid values were assessed at a single time point, limiting the understanding of how changes over time might influence GDM risk.
The authors concluded, "Despite these limitations, the research offers promising insights into lipid ratios as early indicators of gestational diabetes. It paves the way for further studies to validate these markers in diverse populations and explore their integration into routine prenatal screening protocols."
Reference:
Cheng Y, Song J, Zhao L, Yin J, Lu X, Zhao Y, Sun G. The Predictive Effects of Atherogenic Indices and Remnant Cholesterol on Gestational Diabetes Mellitus Risk. Diabetes Metab Syndr Obes. 2025;18:2107-2117 https://doi.org/10.2147/DMSO.S517775
