The association between early pregnancy maternal lipid indicators with gestational diabetes mellitus and pre-eclampsia

The relationship between early pregnancy lipid indicators and gestational diabetes mellitus (GDM) or pre-eclampsia (PE) remains incompletely elucidated. This prospective cohort study explored the associations between seven lipid indicators and GDM and PE among 32,411 pregnant participants. The results suggested that triglycerides (TGs), total cholesterols (TCs), and remnant cholesterols (RCs) were positively associated with both GDM and the composite outcome (GDM/PE). For GDM, compared with the lowest quartile, the highest quartile had odds ratios (ORs) of 1.646 (95% confidence interval [95% CI]: 1.363, 1.988) for TGs, 1.654 (95% CI: 1.241, 2.205) for TCs, and 1.396 (95% CI: 1.189, 1.640) for RCs. For GDM/PE, the corresponding ORs in the highest versus lowest quartile were 1.564 (95% CI: 1.302, 1.877) for TGs, 1.655 (95% CI: 1.253, 2.186) for TCs, and 1.379 (95% CI: 1.180, 1.612) for RCs. Non-HDL-C showed a negative association with GDM and GDM/PE, with ORs of 0.833 (95% CI: 0.758, 0.916) and 0.871 (95% CI: 0.795, 0.954), respectively. TG/HDL-C ratio was positively associated with PE, with an OR of 2.451 (95% CI: 1.369, 4.388). The OR values of the second and third quantiles of HDL-C for PE were 1.706 (95% CI: 1.301, 2.238) and 1.598 (95% CI: 1.170, 2.183), respectively. Nonlinear dose-response relationships were observed for most lipids with the outcomes. Additionally, early pregnancy TG, RC, and TG/HDL-C ratio partially mediated the effect of maternal age on all three outcomes (mediated proportion 2-7%). Non-HDL-C mediated the age-PE pathway (1%). This study simultaneously included multiple lipid parameters for systematic analysis, revealing the impact of dyslipidemia on pregnancy outcomes from a more comprehensive perspective and providing richer evidence for exploring related mechanisms and clinical assessment.