Triglyceride–Glucose Index and TG/HDL Ratio Linked to Higher Risk of Pregnancy Complications: Meta-Analysis
Could simple, routine blood tests help clinicians spot high-risk pregnancies sooner? A new meta-analysis in BMC Pregnancy and Childbirth suggests that the triglyceride–glucose (TyG) index and triglyceride-to-HDL cholesterol (TG/HDL) ratio—both markers of insulin resistance—are significantly associated with a broad spectrum of adverse pregnancy and perinatal outcomes.
Study Design: Meta-Analysis of Over 180,000 Pregnancies
This systematic review pooled data from 23 studies across eight countries, totaling more than 181,000 pregnant women. The review analyzed whether elevated TyG index or TG/HDL ratio (both derived from standard fasting lipids and glucose) in early or later pregnancy could predict complications such as gestational diabetes (GDM), preeclampsia, gestational hypertension, preterm birth, low birth weight, and large for gestational age (LGA) infants. Only observational studies reporting odds ratios were included, with risk of bias and evidence quality rigorously assessed.
Key Findings: Strong Associations Across Multiple Adverse Outcomes
Elevated TyG index was linked to higher odds of:
Gestational hypertension (OR 2.44)
Preeclampsia (OR 2.70 in first trimester, 1.91 later)
GDM (OR 2.15–3.88, depending on timing)
Preterm birth (OR 1.48–1.55)
LGA (OR 2.29)
Elevated TG/HDL ratio increased risk for:
GDM (OR ~2.0)
LGA (OR 4.38)
These associations were significant as early as the first trimester, and persisted when measured later in pregnancy.
Clinical Implications: Simple Biomarkers, Practical Value
The TyG index and TG/HDL ratio are calculated from readily available fasting labs, making them accessible and affordable tools for metabolic risk assessment during pregnancy. Their strong associations with GDM, preeclampsia, and adverse neonatal outcomes suggest they could be useful adjuncts to traditional risk models. However, the authors caution that these markers should supplement—not replace—established risk factors and clinical judgment.
Limitations and Next Steps
While the evidence is compelling, most included studies were from China, raising questions about generalizability. There is also heterogeneity in cut-off values and timing of measurement. Prospective studies are needed to validate trimester-specific and population-specific thresholds, and to clarify their predictive utility in diverse populations.
Conclusion
The TyG index and TG/HDL ratio show promise as adjunctive markers for identifying pregnant women at increased risk for metabolic and vascular complications. Incorporating these simple indices into early antenatal screening may help target monitoring and preventive strategies, but more research is needed before routine adoption.
Key points
Elevated TyG and TG/HDL ratios are associated with increased risks for GDM, preeclampsia, gestational hypertension, preterm birth, and LGA.
These associations are evident as early as the first trimester, supporting early risk stratification.
Both indices can be calculated from standard fasting glucose and lipid panels.
Clinical use should be adjunctive; further validation in diverse populations is required.
Prospective studies should establish optimal cut-off values and evaluate impact on clinical outcomes.
Citation:
Yousif E., Abdalla M.A.I., Abdelrahman O.A., et al. Association of triglyceride–glucose index and triglyceride-to-HDL cholesterol ratio with pregnancy-related risks: a meta-analysis. BMC Pregnancy Childbirth. 2026. https://doi.org/10.1186/s12884-026-09647-4
