TyHGB as a predictive marker for preeclampsia: association with increased risk in pregnant women with normal glucose tolerance

Insulin resistance (IR) is considered a crucial pathophysiological driver of preeclampsia. The triglyceride high-density cholesterol-glucose body index (TyHGB) represents a simple and reliable alternative indicator of IR. This study aimed to test the potential link between TyHGB and the risk of preeclampsia. The study enrolled 23,219 singleton pregnant women. TyHGB levels were taken into account to stratify participants into quartiles. Multivariable regression and subgroup analyses focused on examining the independent association between TyHGB and preeclampsia. Model discrimination was evaluated using receiver operating characteristic (ROC) curves, model calibration was assessed via calibration curves, and clinical utility was determined by decision curve analysis (DCA). The risk of preeclampsia increased gradually with elevated TyHGB levels. According to logistic regression analysis, in the unadjusted model, each 1-unit increase in TyHGB indicated a 1.61-fold higher risk of preeclampsia, with significant differences across all quartiles. This trend persisted in the third and fourth quartiles after adjusting for all confounders (both P < 0.001). Relative to the lowest quartile, the highest TyHGB quartile exhibited the highest risk of preeclampsia (relative risk [RR]: 3.27; 95% confidence interval [CI]: 2.15–4.97). Subgroup analyses indicated that these associations remained largely unchanged regardless of age and parity. The predictive model yielded an area under the curve (AUC) of 0.682 (95% CI: 0.676–0.688), with a sensitivity of 73.85% and a specificity of 53.82%. The calibration curve demonstrated satisfactory calibration (mean absolute error = 0.002). DCA further confirmed the clinically meaningful utility of the model. AUC comparisons showed that TyHGB outperformed other metabolic indices: the triglyceride-glucose (TyG) index, triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, and fasting glucose. TyHGB was strongly and positively associated with preeclampsia, and such association remained consistent after adjustment for multiple confounding factors. These observations revealed that elevated TyHGB indicated a higher risk of preeclampsia. This study contributed to a practical supplementary tool for preeclampsia screening, which may facilitate better maternal and fetal outcomes.