Triglyceride–Glucose Index in Early Gestation: A Marker of Obstetric Risk, study finds

Adverse pregnancy outcomes like gestational diabetes mellitus (GDM) affects 14% of total pregnancies worldwide. GDM is not only associated with perinatal diseases but also a risk factor for chronic diabetes and cardiovascular disease of the mothers and insulin resistance (IR) and obesity of the children. Similarly gestational hypertension (GH) contributes to increased risks of placental abruption, low birth weight, fetal distress, and other adverse pregnancy outcomes even postpartum chronic hypertension. The perplexing situation is that no typical symptoms occur in the early trimester of pregnancy to perceive adverse pregnancy outcomes such as GDM and GH.

Here in lies the importance of triglyceride-glucose (TyG) index which is a comprehensive index based on triglycerides (TG) and fasting blood glucose (FBG), which is a cost-effective and efficient marker of insulin resistance. There is an excellent capacity of the TyG index to evaluate the risk for type 2 diabetes mellitus (T2DM) and cardiovascular diseases.

The aim of the retrospective study was to analyze the predictive capacity and the cut-off points of the TyG index at early pregnancy on adverse pregnancy outcomes such as GDM and GH and to look into the clinical basis for early detection of high-risk groups. The study included 2847 pregnant women and was conducted at Beijing Chaoyang Hospital from October 2020 to January 2023, with the mean maternal age and pre-pregnancy BMI were 31.89±3.70 years and 21.73±4.63 kg/m2. The mean maternal FBG, LDL-C, and Cr concentrations within the normal ranges during early pregnancy were 4.59±0.42 mmol/L, 2.36±0.64 mmol/L, and 46.21±6.15 umol/L, respectively.

TyG index was associated with an increased risk of GDM (adjusted OR 2.16, 95% CI 1.63–2.87, P<0.001) and GH (adjusted OR 1.95, 95% CI 1.14–3.33, P<0.05). Compared with the reference group, the highest TyG index quartile group is more significantly correlated with GDM (OR 2.91, 95% CI 2.12–3.98, P<0.001) and GH (OR 3.26, 95% CI 1.77– 6.02, P<0.001). Similar findings were seen after adjusting for age and pre-pregnancy BMI, compared with the reference group, the highest TyG index quartile group is still more significantly correlated with GDM (OR 2.44, 95% CI 1.77–3.37, P<0.001) and GH (OR 3.23, 95% CI 1.72–6.07, P<0.001).

The TyG index cut-off point for diagnosing GDM is 8.345 (AUC 0.630, 95% CI 0.600–0.660, P<0.0001, sensitivity=53.33%, specificity=70.19%). The TyG index cut-off point for diagnosing GH is 8.425 (AUC 0.622, 95% CI 0.578–0.665, P<0.0001, sensitivity=46.67%, specificity=76.19%).

The TyG index shows a better predictive capability than FBG (AUC 0.630 vs. 0.590, P<0.05) and TG (AUC 0.630 vs. 0.612, P=0.0001) in GDM. The TyG index shows a better predictive capability than TG (AUC 0.622 vs. 0.608, P<0.05) in GH.

Every 1-unit elevated maternal TyG index in the early trimester of pregnancy was associated with GDM with an OR of 2.16 and GH with an OR of 1.95.

TyG index, an emerging biomarker, had a wonderful predictive capacity on the incidence of GDM and GH with AUC of 0.630 and 0.622, respectively. A meta-analysis suggested that a higher TyG index can predict GDM in Asian women but not in non-Asian women suggesting the potential ethnicity difference of the association.

The limitations of this study were that TyG index was measured in the early trimester of pregnancy rather than dynamic assessment throughout pregnancy and the sample size of the study was relatively small. The cross-sectional design could not establish a causal relationship between the TyG index and GDM or GH.

HIGHLIGHTS:

*A higher TyG index in the early trimester of pregnancy was closely associated with the development of GDM and GH among women.

*TyG- a brilliant indicator for early surveillance of high-risk populations. Every 1-unit elevated maternal TyG index in the early trimester of pregnancy was associated with GDM with an OR of 2.16 and GH with an OR of 1.95.

*The TyG index, derived from routine prenatal tests including TG and FBG, offers an accessible, objective tool for early prediction of adverse pregnancy outcomes, enabling targeted management and timely intervention.

Reference: He, X., He, X., Zhou, Y. et al. Associations between triglyceride-glucose index in the early trimester of pregnancy and adverse pregnancy outcomes. BMC Pregnancy Childbirth 25, 986 (2025). https://doi.org/10.1186/s12884-025-08121-x