Association between the ratio of serum uric acid to high-density lipoprotein cholesterol in early pregnancy and the incidence of gestational diabetes mellitus: a prospective cohort study

To investigate the ratio of uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) (UHR) in early pregnancy and the risk of gestational diabetes mellitus (GDM), and to evaluate its potential predictive value as a risk indicator for early identification of GDM among pregnant women in Xinjiang. The prospective cohort study was conducted at the First Affiliated Hospital of Shihezi University from May 2022 to December 2024. A total of 1424 women with singleton pregnancies in the first trimester were enrolled from the Perinatal Clinic and Department of Obstetrics. A questionnaire survey was administered to collect basic information, and participants were followed up from the second trimester to the third trimester. Fasting venous blood samples were collected from all participants before 14 weeks of gestation to measure UA and HDL-C levels and calculate UHR. GDM was diagnosed based on the oral glucose tolerance test (OGTT) performed at 24–28 weeks of gestation. Restricted cubic spline (RCS) model and multivariate logistic regression were used to analyze the dose-response relationship and the association between UHR and GDM. Subgroup analyses were conducted to explore the relationship within different subgroups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of UHR for GDM. The incidence of GDM in this study was 7.16%. The median UHR of pregnant women with GDM 15.88 (12.42, 19.36) was significantly higher than that of pregnant women without GDM 12.45 (10.17, 15.54) ( p < 0. 001). The RCS model revealed a significant positive association between rising UHR levels and GDM risk (P for overall = 0.002). Multivariate logistic regression analysis revealed that women in the highest quartile (Q4) of UHR had a significantly increased probability of developing GDM compared with those in the lowest quartile (Q1) (OR = 3.717, 95% CI: 1.710 - 8.081, p = 0.001). The test for linear trend indicated a progressively increasing risk of GDM with higher first-trimester UHR levels (P for trend < 0.001). Subgroup analyses suggested that among women with a pre-pregnancy BMI of 18.5–23.9 kg/m 2 , there appeared to be a positive association between higher UHR levels and GDM (OR = 1.20, 95% CI: 1.10 - 1.30). ROC curve analysis demonstrated that the UA/HDL-C ratio had an area under the curve (AUC) of 0.833 for predicting GDM, which was superior to that of UA or HDL-C alone. Elevated first-trimester UHR was found to be independently associated with an increased risk of GDM in this cohort and may serve as a promising candidate biomarker for early risk prediction of GDM. Moreover, combining UHR with traditional risk factors may enhance predictive accuracy, supporting its potential utility in early GDM risk assessment.