Elevated triglyceride glucose-body mass index is associated with a higher risk of reduced cumulative live birth and adverse pregnancy outcomes in women undergoing assisted reproductive technology: a retrospective cohort study.

BACKGROUND

Insulin resistance has been linked to adverse reproductive and pregnancy outcomes. The triglyceride glucose-body mass index (TyG-BMI) serves as a simple and cost-effective surrogate marker of insulin resistance. This study aimed to investigate the association between maternal TyG-BMI and cumulative live birth as well as pregnancy outcomes in women undergoing assisted reproductive technology.

METHODS

This retrospective cohort study included 53,393 women undergoing assisted reproductive technology at the Reproductive and Genetic Hospital of CITIC-Xiangya, China, between January 1, 2017, and March 31, 2023. Associations between baseline TyG-BMI and assisted pregnancy outcomes were estimated using modified Poisson regression and restricted cubic splines.

RESULTS

A significant linear inverse association was observed between TyG-BMI and cumulative live birth rate (P-overall = 0.029). Compared with women in the lowest TyG-BMI tertile (≤177), those in the highest tertile (>203) had a lower cumulative live birth rate (aRR 0.973; 95% confidence interval 0.956-0.991). Higher TyG-BMI was also associated with higher risks of first-trimester miscarriage (aRR, 1.090; 95% confidence interval 1.002-1.185), second- or third-trimester fetal loss (aRR 1.694; 95% confidence interval 1.481-1.938), preterm birth (aRR 1.244; 95% confidence interval 1.170-1.323), and macrosomia (aRR 2.352; 95% confidence interval 2.060-2.685).

CONCLUSIONS

Higher maternal TyG-BMI is associated with reduced cumulative live birth rates and higher risks of adverse pregnancy outcomes including miscarriage, preterm birth, and macrosomia following assisted reproductive technology. TyG-BMI may be a potential and cost-effective marker associated with adverse reproductive outcomes in women undergoing fertility treatment.

CLINICAL TRIAL REGISTRATION: https://www.clinicaltrials.gov, identifier NCT05404464.