Association of triglyceride–glucose index and triglyceride-to-HDL cholesterol ratio with pregnancy-related risks: a meta-analysis

BACKGROUND: Insulin resistance has a role in adverse pregnancy outcomes. Both triglyceride-glucose (TyG) index and triglyceride-to-high-density lipoprotein cholesterol (TG/HDL) ratio have been considered as indicators of insulin resistance. However, existing studies evaluating their association with pregnancy complications have reported inconsistent findings. This systematic review sought to measure the link between these markers and the risk of unfavorable pregnancy and perinatal outcomes. METHODS: The systematic review followed the PRISMA guidelines for methodology and reporting. Systematic searches were conducted across PubMed, Embase, Web of Science, and ProQuest in March 2026. The relations between the TyG index, TG/HDL, and adverse pregnancy outcomes were analyzed. Pooled odds ratios (ORs) along with 95% confidence intervals (CIs) were obtained using R version 4.3.2. RESULTS: A total of 23 studies comprising more than 180,000 participants were included. Elevated TyG index was associated with several adverse pregnancy complications such as gestational hypertension (OR = 2.44, 95% CI: 1.41-4.24), preeclampsia (OR = 2.70, 95% CI: 2.00-3.65), gestational diabetes mellitus (GDM) (OR = 2.15, 95% CI: 1.60-2.90), preterm birth (OR = 1.48, 95% CI: 1.15-1.90), and large for gestational age (LGA) (OR = 2.29, 95% CI: 1.18-4.46). Similarly, an elevated TG/HDL ratio was associated with an increased risk of GDM (OR = 2.02, 95% CI: 1.30-3.14) and LGA (OR = 4.38, 95% CI: 2.09-9.18). CONCLUSION: Elevated TyG index and TG/HDL ratio are related to a greater risk of adverse pregnancy and perinatal outcomes. These findings suggest that the TyG index and TG/HDL ratio may serve as adjunctive risk markers for adverse pregnancy outcomes, although further validation is needed before clinical application.