The association between early pregnancy maternal lipid indicators with gestational diabetes mellitus and pre-eclampsia

The relationship between early pregnancy lipid indicators and gestational diabetes mellitus (GDM) or pre-eclampsia (PE) remains incompletely elucidated. This prospective cohort study explored the associations between seven lipid indicators and GDM and PE among 32,411 pregnant participants. The results suggested that triglycerides (TG), total cholesterol (TC), and remnant cholesterol (RC) were positively associated with both GDM and the composite outcome (GDM/PE). For GDM, compared with the lowest quartile, the highest quartile had ORs of 1.646 (95%CI: 1.363-1.988) for TG, 1.654 (95%CI: 1.241-2.205) for TC, and 1.396 (95%CI: 1.189-1.640) for RC. For GDM/PE, the corresponding ORs in the highest versus lowest quartile were 1.564 (95%CI: 1.302-1.877) for TG, 1.655 (95%CI: 1.253-2.186) for TC, and 1.379 (95%CI: 1.180-1.612) for RC. Non-high-density lipoprotein cholesterol (Non-HDL-C) showed a negative association with GDM and GDM/PE, with ORs of 0.833 (95%CI: 0.758-0.916) and 0.871 (95%CI: 0.795-0.954), respectively. Triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C ratio) were positively associated with PE, with an OR of 2.451 (95%CI: 1.369-4.388). The OR values of the second and third quantiles of HDL-C for PE were 1.706 (95%CI: 1.301-2.238) and 1.598 (95%CI: 1.170-2.183), respectively. Nonlinear dose-response relationships were observed for most lipids with the outcomes. Additionally, early-pregnancy TG, RC, and TG/HDL-C ratio partially mediated the effect of maternal age on all three outcomes (mediated proportion 2-7%); Non-HDL-C mediated the age-PE pathway (1%). Our findings revealed that multiple early pregnancy lipid indicators independently influence GDM and PE risk, suggesting early dyslipidemia monitoring and management may mitigate these complications.