Lipid profiles and risk of gestational diabetes mellitus in women with isolated TPOAb positivity during early pregnancy

Isolated thyroid peroxidative antibody (TPOAb) positivity has been linked to adverse pregnancy outcomes including gestational diabetes mellitus (GDM). Elevated lipids are reported as pivotal risk factors. Current researches indicated 75 g oral glucose tolerance test (OGTT) in early pregnancy has limited predictive ability for GDM. The lipid profiles in isolated TPOAb positive pregnant women and their correlation with GDM were unclear. To delineate the specific lipid profile characteristics in pregnant women with isolated TPOAb positivity and to identify potential lipid biomarkers for early prediction of GDM. Euthyroid pregnant women were enrolled in the first trimester and underwent OGTT in the second trimester. Participants were divided into four groups based on TPOAb status and OGTT results. Untargeted liquid chromatography-mass spectrometry (LC–MS) was used to identify lipid molecules. Of 88 women, 43.5% (20/46) with TPOAb positivity and 35.7% (15/42) without were diagnosed with GDM. Low-density lipoprotein (LDL) levels were positively associated with GDM risk in TPOAb positive women. LC–MS analysis identified 13 different lipid molecules significantly correlated with OGTT results. A nomogram was constructed to predict the occurrence of GDM. Elevated first-trimester LDL levels are associated with increased GDM risk in isolated TPOAb-positive women. Furthermore, PC (20:0/16:0) and TG (16:0/16:0/18:1), combined with TSH and TPOAb titers, are potential biomarkers for early prediction of GDM in this specific population.