Second-Trimester TGI Vital Predictor of Adverse Outcomes in Gestational Diabetes, study reveals

The findings, published in the Journal of Diabetes Investigation, suggest that the TyG index is a valuable tool for early prediction and prevention of adverse outcomes in women with gestational diabetes mellitus (GDM).

Gestational diabetes mellitus affects a significant number of pregnancies, leading to various risks, including preeclampsia, preterm birth, and fetal complications. The TyG index, which reflects insulin resistance by combining triglyceride and glucose levels, has emerged as a critical tool in identifying women at higher risk for adverse events during pregnancy.

Against the above background, Zhonghua Shi, Nanjing Medical University, Changzhou, China, and colleagues aimed to evaluate the performance of the TyG index in predicting the risk of developing adverse outcomes in women with gestational diabetes mellitus.

For this purpose, the researchers conducted a retrospective multicenter cohort study comprising 8,808 pregnant women with GDM in two grade-A tertiary hospitals in China during 2018–2022. The TyG index was defined as ln [triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2].

Generalized linear models identified significant adverse outcomes related to gestational diabetes mellitus as the primary endpoints. Multivariable logistic regression models assessed their association with the triglyceride-glucose index. Areas under the receiver operating characteristic curves were used to predict adverse pregnancy outcomes, and the predictive accuracy was confirmed in the sensitivity analysis dataset and validation cohort.

The researchers reported the following findings:

• The triglyceride-glucose index was associated with preeclampsia, severe preeclampsia, preterm birth, placenta accreta spectrum, and macrosomia before and after adjusting for confounding factors.
• The predictive performance of the triglyceride-glucose index was relatively moderate. Incorporating the triglyceride-glucose index into the baseline clinical risk model improved the area under curves for the diagnosis of preeclampsia (0.749 versus 0.766) and macrosomia (0.664 versus 0.676). These predictive models exhibited good calibration and robustness.

In conclusion, this study provided a thorough evaluation of the second-trimester triglyceride-glucose index as a predictor of various adverse obstetric and neonatal outcomes in women with gestational diabetes. The TyG index was strongly linked to an increased risk of preeclampsia, severe preeclampsia, preterm birth, placenta accreta spectrum, and macrosomia, independent of other risk factors. Its predictive value for these outcomes was found to be moderate.

Integrating the TyG index into traditional clinical risk models significantly enhanced predictive accuracy. This index can aid in risk stratification and complication prediction in women with GDM, allowing for the early identification of high-risk individuals and the implementation of targeted treatment strategies.

"Future research should explore the influence of pre-pregnancy and first-trimester TyG index levels on adverse pregnancy outcomes and investigate the causal mechanisms and potential public health interventions," the researchers wrote.

Reference:

Bai, X., Zhu, Q., Wang, W., Kan, S., Hu, S., Hao, R., Wang, S., & Shi, Z. Second-trimester triglyceride-glucose index to predict adverse outcomes in women with gestational diabetes mellitus: A retrospective multicenter cohort study. Journal of Diabetes Investigation. https://doi.org/10.1111/jdi.14269