Atherogenic index of plasma and risk of hypertensive disorders of pregnancy in women with gestational diabetes mellitus: a two-center cohort study

Abstract Hypertensive disorders of pregnancy (HDPs) are major contributors to maternal and neonatal morbidity and are closely linked to metabolic disturbances. Women with gestational diabetes mellitus (GDM) exhibit significant lipid abnormalities, yet whether atherogenic lipid indices predict hypertensive complications in this population remains unclear. This study evaluated the predictive value of the atherogenic index of plasma (AIP) and cumulative AIP for HDPs and neonatal outcomes in women with GDM. In this two-center retrospective cohort study, a total of 3967 women with GDM were included. AIP was calculated as log10 (TG/HDL-C). Cumulative AIP was estimated as the mean AIP values measured during the second and third trimesters multiplied by the corresponding exposure time. Adverse outcomes were identified using generalized linear models with P for trend <0.05. Associations between AIP indices and outcomes were evaluated using regression models, dose–response analyses, and subgroup analyses. Predictive performance was assessed using receiver operating characteristic analysis. Both AIP and cumulative AIP were significantly associated with HDPs, including preeclampsia and preeclampsia with severe features, as well as neonatal intensive care unit (NICU) admission (all P < 0.05). Incorporating AIP into clinical models improved discrimination for preeclampsia (AUC 0.699 vs. 0.780, P = 0.025), severe preeclampsia (AUC 0.729 vs. 0.874, P = 0.002), and NICU admission (AUC 0.588 vs. 0.643, P = 0.029). Cumulative AIP produced similar improvements. In conclusion, elevated AIP and cumulative AIP are independently associated with increased risks of HDPs and NICU admission in women with GDM and may serve as practical cardiometabolic biomarkers for risk stratification.