Remnant cholesterol is associated with gestational diabetes mellitus in early pregnancy: a single-center retrospective study

Q: What are the key findings of this study?

Each 1 mg/dL increase in early pregnancy remnant cholesterol was independently associated with 14.1% higher odds of gestational diabetes mellitus (OR 1.141, 95% CI 1.081–1.205, P<0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Gestational diabetes mellitus (GDM) (n=274). Intervention: Elevated remnant cholesterol (RC) levels in early pregnancy (per 1 mg/dL increase; or Tertile 3 ≥28.13 mg/dL) vs. Lower remnant cholesterol levels (or Tertile 1 ≤21.66 mg/dL). Primary outcome: Incidence of gestational diabetes mellitus (GDM) diagnosed by 75-g, 2-h OGTT at 24–28 weeks of gestation (OR 1.141 per 1 mg/dL increase (T3 vs T1: OR 7.347), 95% CI 1.081-1.205, p=<0.001).

Q: What does this research mean for the field?

Elevated remnant cholesterol levels in early pregnancy are independently associated with an increased risk of gestational diabetes mellitus. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Xiaohua Wu; Lixian Yi; Yumiao Zhang; Xixi Shen; Jingfen Lu; Ximing Li; Yuting Fei; Hao Shen; Jie Xiao; Yan Zhang

doi:10.1186/s12884-026-10244-8

November 6, 2026BMC Pregnancy and ChildbirthOpen Access

Remnant cholesterol is associated with gestational diabetes mellitus in early pregnancy: a single-center retrospective study

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Key result

Early pregnancy remnant cholesterol is linked to ~14% higher GDM odds per 1 mg/dL.

OR 1.141 per 1 mg/dL increase (T3 vs T1: OR 7.347)
95% CI 1.081-1.205
P<0.001
n=274

Why the study?

The association between remnant cholesterol and the risk of gestational diabetes mellitus in early pregnancy remains incompletely understood.

Is elevated first-trimester remnant cholesterol independently associated with and predictive of gestational diabetes mellitus in pregnant women at 12-14 weeks of gestation?

Study Design

Type

Cohort (n=274)

Multicenter

No

Structured PICO

Is elevated first-trimester remnant cholesterol independently associated with and predictive of gestational diabetes mellitus in pregnant women at 12-14 weeks of gestation?

P

Population

274 singleton Han Chinese pregnant women at 12–14 weeks of gestation without a family history of diabetes or thyroid disease, followed until 24–28 weeks of gestation at a single center in Suzhou, China.

E

Exposure

First-trimester calculated fasting remnant cholesterol (RC = TC - HDL-C - LDL-C), evaluated as a continuous variable (per 1 mg/dL increase) and across tertiles (T3: ≥28.13 mg/dL, T2: 21.66 < RC < 28.13 mg/dL).

C

Comparator

Lowest tertile of remnant cholesterol (T1: ≤21.66 mg/dL) and conventional lipid parameters / clinical risk factor reference model (age and pre-pregnancy BMI).

O

Outcome

Incidence of gestational diabetes mellitus (GDM) diagnosed at 24-28 weeks of gestation via 75-g, 2-h oral glucose tolerance test (fasting plasma glucose ≥5.1 mmol/L, 1-h plasma glucose ≥10.0 mmol/L, or 2-h plasma glucose ≥8.5 mmol/L).hard clinical

Main Result

Odds Ratio: 1.141 (95% CI 1.081–1.205)

Absolute Event Rate: 16.3% vs 2.11%

p-value: p=<0.001

Elevated first-trimester remnant cholesterol is independently associated with a higher risk of gestational diabetes mellitus and significantly improves early risk discrimination when added to maternal age and pre-pregnancy BMI.

Limitations

Retrospective, single-center design may limit generalizability
Modest sample size (274 participants, 22 GDM events) constrained statistical power for subgroup analyses
Exclusion of women with a family history of diabetes and comorbidities resulted in a relatively low-risk cohort and potential selection bias
Lack of data on gestational weight gain, dietary habits, and physical activity
Remnant cholesterol was calculated from fasting samples, limiting direct comparison with non-fasting cohorts
Relatively modest sample size (274 participants, 22 GDM events) constrained statistical power for subgroup analyses
Lack of data on gestational weight gain, dietary habits, or physical activity
RC was obtained from fasting samples, requiring caution when comparing cut-off values with non-fasting cohorts
Exclusion of women with a family history of diabetes and other comorbidities may have introduced selection bias and resulted in a relatively low-risk cohort

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Implication

Remnant cholesterol may enhance first-trimester GDM prediction beyond age and BMI; leaves open prospective validation before clinical adoption.

Abstract

The association between remnant cholesterol (RC) and the risk of gestational diabetes mellitus (GDM) remains incompletely understood. This study aimed to investigate the relationship between RC and GDM in pregnant women at 12–14 weeks of gestation. This single-center retrospective study included 274 pregnant women who received prenatal care and were screened for eligibility at Wujiang Fifth Hospital, affiliated with Suzhou Vocational Health College, Suzhou, China, between January and December 2024. Firth penalized logistic regression analysis was used to estimate the association between RC and GDM risk. Receiver operating characteristic (ROC) curve analysis was performed to further evaluate the discriminatory performance of RC for GDM. RC levels were obtained by calculation. The overall incidence of GDM was 8.03%. In this retrospective study, elevated RC levels were independently associated with GDM among pregnant women. After adjustment for established risk factors, including age and pre-pregnancy BMI, each 1 mg/dL increase in RC was associated with a 14.1% increase in the odds of GDM. Notably, women in the highest RC tertile exhibited approximately 7.347 times the GDM risk compared with those in the lowest tertile. Furthermore, adding RC to the reference model (age and pre-pregnancy BMI) increased the AUC from 0.749 (95% CI: 0.628–0.870) to 0.859 (95% CI: 0.759–0.959), representing a ΔAUC of 0.110 (DeLong test, P = 0.014). This study demonstrated an independent association between elevated RC levels and GDM among pregnant women at 12–14 weeks of gestation. Not applicable.

Discussion

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Cite This Study

Wu et al. (2026) conducted a cohort in Gestational diabetes mellitus (GDM) (n=274). Elevated remnant cholesterol (RC) levels in early pregnancy (per 1 mg/dL increase; or Tertile 3 ≥28.13 mg/dL) vs. Lower remnant cholesterol levels (or Tertile 1 ≤21.66 mg/dL) was evaluated on Incidence of gestational diabetes mellitus (GDM) diagnosed by 75-g, 2-h OGTT at 24–28 weeks of gestation (OR 1.141 per 1 mg/dL increase (T3 vs T1: OR 7.347), 95% CI 1.081-1.205, p=<0.001). Each 1 mg/dL increase in early pregnancy remnant cholesterol was independently associated with 14.1% higher odds of gestational diabetes mellitus (OR 1.141, 95% CI 1.081–1.205, P<0.001).

synapsesocial.com/papers/6af0e999de503f3774140a57 https://doi.org/10.1186/s12884-026-10244-8

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Remnant cholesterol is associated with gestational diabetes mellitus in early pregnancy: a single-center retrospective study

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Remnant cholesterol is associated with gestational diabetes mellitus in early pregnancy: a single-center retrospective study

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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