Can an early pregnancy lipid ratio help identify women at higher risk for gestational complications? A retrospective cohort study published in Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy examined the association between the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and the risk of gestational diabetes mellitus (GDM) and neonatal hypoglycemia (NH).

The study included 17,056 women with singleton pregnancies who underwent fasting lipid assessment in early pregnancy. The TG/HDL-C ratio was derived from these measurements. Propensity score matching was used to balance baseline characteristics, resulting in 10,131 individuals in the GDM analysis and 2,123 in the NH analysis. Logistic regression models evaluated associations, while restricted cubic spline analysis assessed nonlinear patterns. Mediation analysis quantified indirect associations, and subgroup analyses explored variation across clinical subgroups.

Higher TG/HDL-C quartiles were associated with progressively increased odds of GDM. Adjusted odds ratios for quartiles Q2, Q3, and Q4 were 1.20, 1.44, and 1.69, respectively. A nonlinear association was observed, with an inflection point at 2.91, below which the increase in GDM risk was more pronounced. For NH, an association was identified only in the highest quartile, without a consistent dose-response gradient.

Mediation analysis showed that 11.14% of the association between TG/HDL-C ratio and NH was linked to GDM, while gestational hypertension contributed 1.41%. These findings indicate that an elevated TG/HDL-C ratio in early pregnancy is associated with higher GDM risk and may aid early risk stratification, with a modest and partially linked association with NH.