Predictive value of early pregnancy serum TC/HDL-C ratio for gestational diabetes mellitus risk

Li Xiaofang; Li Sha; Chen Tao; Li Xirong; Yang Guangqiong; Zhang Ling; Yang Zixuan; Cheng Jing

doi:10.11986/j.issn.1673-873X.2025.01.14

Abstract：Objective To explore the predictive value of the early pregnancy serum total cholesterol/high-density lipoprotein cholesterol(TC/HDL-C)ratio for the risk of gestational diabetes mellitus(GDM),aiming to provide a reference for clinical decision-making.Methods A total of 196 pregnant women in early pregnancy(4-12 weeks)who attended antenatal care at a hospital in Sichuan Province from February 2022 to February 2024 were selected as the study participants.Clinical data were collected,and the TC/HDL-C ratio was calculated during early pregnancy.At 24-28 weeks of gestation,a 75 g oral glucose tolerance test(OGTT)was conducted for GDM screening.Based on the occurrence of GDM,participants were allo-cated to the GDM group and the normal group.Receiver operating characteristic(ROC)curve analysis was performed to as-sess the predictive value of early pregnancy serum TC,HDL-C,and TC/HDL-C for GDM occurrence.Multiple logistic re-gression analysis was used to identify factors influencing the development of GDM.Results In the GDM group,serum TC and TC/HDL-C levels were higher,and HDL-C levels were lower than those in the normal group,with statistically signifi-cant differences(P<0.05).The optimal cutoff values for predicting GDM were:TC≥4.45 mmol/L,HDL-C≥1.55 mmol/L,and TC/HDL-C≥2.81.The areas under the ROC curve(AUC)for TC,HDL-C,and TC/HDL-C in predicting GDM were 0.837(95%CI:0.792-0.887),0.712(95%CI:0.667-0.762),and 0.908(95%CI:0.863-0.958),re-spectively.There were no significant differences in age,height,systolic blood pressure,diastolic blood pressure,gestational weeks at first diagnosis,number of pregnancies,number of deliveries,education,smoking history and drinking history,and previous abortion history between the 2 groups(P>0.05);the pre-pregnancy BMI,fasting blood glucose,fasting insulin,glycosylated hemoglobin,and fibrinogen of the GDM group were significantly higher than those of the normal group(P<0.05).Logistic regression analysis revealed that pre-pregnancy BMI≥24 kg/m2(OR=2.073,95%CI:1.243-3.458),glycated hemoglobin≥5.52%(OR=2.252,95%CI:1.353-3.749),and TC/HDL-C≥2.81(OR=3.196,95%CI:1.765-5.789)were independent risk factors for GDM occurrence(P<0.05).Conclusion The early pregnancy serum TC/HDL-C ratio has important predictive value for the risk of GDM.An elevated ratio is closely associated with the occurrence of GDM and can serve as a reliable indicator for early screening and intervention.