Triglyceride/High-Density Lipoprotein Cholesterol (TG/HDL) Ratio May Predict Gestational Diabetes and Worse Cardiometabolic Profile

Introduction Current approaches to diagnosing and managing gestational diabetes mellitus (GDM) do not account for the diverse cardiometabolic (CM) profiles of pregnant women. The triglyceride/high-density lipoprotein cholesterol (TG/HDL) ratio is recognized as a useful marker of CM risk, but its significance during pregnancy remains unclear. Objective The objective of this study is to evaluate whether the TG/HDL ratio is associated with distinct CM profiles and the timing of GDM diagnosis. Methods This cross-sectional study included 651 women aged 18 years or older who received specialized antenatal care for GDM between January 2008 and November 2021. The TG/HDL ratio was assessed during the second or third trimester and categorized into tertiles: T1 (<2.22), T2 (2.22-3.37), and T3 (>3.37). Maternal characteristics and the timing of GDM diagnosis (first trimester vs. second/third trimester) were compared across tertiles. Results The mean TG/HDL ratio was 3.1 (SD 1.7). Increasing tertiles were associated with a progressive worsening of CM indicators. Women in higher tertiles had significantly higher pre-gestational BMI, fasting glucose, two-hour oral glucose tolerance test glucose, glycated hemoglobin, and triglyceride-glucose index values (all p < 0.05). The prevalence of obesity and GDM diagnosed in the second or third trimester also rose significantly across tertiles. A borderline association with hypertension was noted. Cesarean delivery rates were higher in the highest tertile, while other maternal-fetal complications showed no significant differences. Conclusions Elevated TG/HDL ratios are associated with a poorer CM profile and a higher likelihood of GDM diagnosis in the second or third trimester.