[Early-and mid-trimester glycolipid metabolism indicators for predicting adverse pregnancy outcomes in normoglycemic women].

Objective

To explore the predictive value of early-and mid-trimester glycolipid metabolic indicators for adverse pregnancy outcomes in pregnant women with normal glucose levels.

Methods

A total of 12 457 pregnant women admitted to Yantai Yantaishan Hospital from January 2020 to December 2024 were retrospectively included. According to the occurrence of adverse pregnancy outcomes, they were divided into an adverse pregnancy outcome group (n=852) and a normal pregnancy outcome group (n=11 605). General data, pregnancy-related information, lipid profile, and fasting plasma glucose (FPG) in early pregnancy (gestational age≤14 weeks; T1), and oral glucose tolerance test (OGTT) results in the second trimester (24-28 weeks; T2) were compared between the two groups. The participants were randomly assigned to a training set (n=8 712) and a validation set (n=3 745) in a 7∶3 ratio. Multivariable logistic regression was applied in the training set to identify independent risk factors for adverse pregnancy outcomes, and a nomogram prediction model was constructed. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve were used to evaluate the discrimination, calibration, and clinical applicability of the model, respectively.

Results

The overall age was (30.9±3.8) years, BMI was (22.77±2.12) kg/m², T1 FPG was (4.43±0.29) mmol/L, T2 FPG was (4.51±0.27) mmol/L, the second-trimester 1 h glucose was (8.54±0.43) mmol/L, and the second-trimester 2 h glucose was (7.10±0.54) mmol/L. Multivariable logistic regression analysis showed that age (OR=1.126, 95%CI: 1.080-1.175), history of adverse pregnancy outcomes (OR=2.080, 95%CI 1.023-4.232), ΔMAP (the change in mean arterial pressure from the first to the second trimester) (OR=1.162, 95%CI 1.124-1.202), the TG/HDL-C ratio (OR=18.849, 95%CI: 11.512-30.862), T1 FPG (OR=3.191, 95%CI 2.120-4.803), ΔFPG (T2 FPG-T1 FPG) (OR=1.154, 95%CI: 1.036-1.285), ΔT2(1 h-FPG) (T2 1 h glucose-FPG) (OR=3.427, 95%CI: 2.674-4.391), and ΔT2(2 h-FPG) (T2 2 h glucose-FPG) (OR=4.155, 95%CI: 3.306-5.221) were risk factors for adverse pregnancy outcomes (all P<0.05). The AUC of the nomogram was 0.902 (95%CI: 0.884-0.919) in the training set and 0.895 (95%CI: 0.877-0.913) in the validation set. The calibration curve showed good agreement between predicted and observed probabilities (Hosmer-Lemeshow test: training set, P=0.708; validation set, P=0.102), and decision curve analysis indicated a net clinical benefit over a threshold probability range of 0.05 to 0.95.

Conclusions

Age, history of adverse pregnancy outcomes, ΔMAP, the TG/HDL-C ratio, and dglycemic dynamic indicators during early and mid-trimester are independent predictors of adverse pregnancy outcomes in pregnant women with normal perinatal glucose levels. The nomogram constructed based on these factors demonstrates good discrimination, calibration, and clinical utility, and can serve as a quantitative tool for early risk identification in this population.