Stress-induced hyperglycemia ratio and gestational diabetes mellitus: a cross-sectional study based on NHANES database.

BACKGROUND

Stress-induced hyperglycemia ratio (SHR) has shown strong correlations with diabetes risk. However, its relationship with gestational diabetes mellitus (GDM) remains an area of limited research.

OBJECTIVE

Based on the National Health and Nutrition Examination Survey (NHANES) database, this cross-sectional study aims to explore the association between SHR and GDM.

METHODS

The study included 461 pregnant women from NHANES between 1999 and 2016. Logistic regression analysis was performed to investigate the relation between SHR and GDM, as well as the weighted tertiles of SHR. Stratified and subgroup analyses assessed the association between SHR and GDM. Restricted cubic splines (RCS) delineated the nonlinear relationship between SHR and GDM. Moreover, a two-segment linear regression model was employed to test the threshold effect of SHR on GDM. Stratified analysis was conducted by stratifying by months of pregnancy.

RESULTS

Among the 461 eligible women included in the study, SHR was a critical risk factor for GDM. Higher SHR values were associated with an elevated likelihood of developing GDM after accounting for other variables (OR: 1.77, 95% CI: 1.37-2.28, p < 0.001). This relationship was maintained across different SHR levels when analyzed in tertiles (p < 0.05). Further subgroup analyses based on education level and alcohol consumption status showed a consistent positive correlation between SHR and GDM risk in each group. A nonlinear relationship between SHR and GDM risk was confirmed by RCS. Threshold effect analysis further revealed a significant positive association between SHR and GDM when SHR was ≤ 15.75, whereas no significant association was observed beyond this threshold. The results of stratified analysis showed a significant positive correlation between SHR and GDM from 1 to 5 months of pregnancy (OR = 2.16, 95% CI: 1.12-4.16, p = 0.026). However, no significant SHR-GDM association was observed from 6 to 10 months of pregnancy.

CONCLUSION

SHR is significantly positively correlated with an increased risk of GDM in early pregnancy. These results highlight the potential utility of SHR as a clinical marker for early identification and intervention in GDM risk cases.