Association of atherogenic index of plasma and its modified indices with gestational diabetes mellitus: a prospective cohort study based on the Korean population.
Gestational diabetes mellitus (GDM) is a common pregnancy complication, yet current diagnosis at 24-28 weeks may occur after metabolic changes have already begun. The atherogenic index of plasma (AIP, log₁₀[TG/HDL-C]) has shown promise for early GDM risk stratification, but it does not incorporate obesity-related parameters. We evaluated whether first-trimester AIP and its modified indices, AIP-BMI and AIP-WC, are associated with subsequent GDM and compared their predictive performance.
This secondary analysis of a prospective Korean cohort included 581 women with singleton pregnancies. AIP, AIP-BMI (AIP × BMI), and AIP-WC (AIP × waist circumference) were calculated using fasting measurements obtained at 10-14 weeks of gestation; BMI and waist circumference were algebraically reconstructed from the full-precision components of the hepatic steatosis index and fatty liver index because contemporaneous direct measurements were unavailable in the public dataset. GDM was diagnosed at 24-28 weeks using the two-step ACOG approach. Multivariable logistic regression, restricted cubic spline, sensitivity, subgroup, and receiver operating characteristic analyses were performed.
GDM occurred in 36 women (6.2%). In the fully adjusted model, AIP (per 0.1-unit increase: OR 1.66, 95% CI 1.36-2.03; Q3 vs Q1: OR 7.86, 95% CI 1.93-32.08), AIP-BMI (OR 1.20, 95% CI 1.11-1.31), and AIP-WC (OR 1.05, 95% CI 1.03-1.08) were associated with GDM (all P < 0.001). Overall associations were significant in restricted cubic spline analyses, without evidence of nonlinearity. Among individual indices, AIP-BMI had the largest apparent AUC (83.05%, sensitivity 81%, specificity 80%), followed by AIP-WC (81.32%) and AIP (78.66%). The AIP + AIP-BMI model had the largest apparent AUC among evaluated models (84.19%, sensitivity 81%, specificity 81%). Results remained broadly consistent in sensitivity analyses excluding participants with NAFLD, whereas subgroup analyses were underpowered to detect interactions.
First-trimester AIP, AIP-BMI, and AIP-WC were associated with subsequent GDM, and AIP-BMI showed higher apparent discrimination than AIP alone in this sample. These findings require confirmation in larger cohorts with directly measured anthropometry and appropriate internal and external validation.
This secondary analysis of a prospective Korean cohort included 581 women with singleton pregnancies. AIP, AIP-BMI (AIP × BMI), and AIP-WC (AIP × waist circumference) were calculated using fasting measurements obtained at 10-14 weeks of gestation; BMI and waist circumference were algebraically reconstructed from the full-precision components of the hepatic steatosis index and fatty liver index because contemporaneous direct measurements were unavailable in the public dataset. GDM was diagnosed at 24-28 weeks using the two-step ACOG approach. Multivariable logistic regression, restricted cubic spline, sensitivity, subgroup, and receiver operating characteristic analyses were performed.
GDM occurred in 36 women (6.2%). In the fully adjusted model, AIP (per 0.1-unit increase: OR 1.66, 95% CI 1.36-2.03; Q3 vs Q1: OR 7.86, 95% CI 1.93-32.08), AIP-BMI (OR 1.20, 95% CI 1.11-1.31), and AIP-WC (OR 1.05, 95% CI 1.03-1.08) were associated with GDM (all P < 0.001). Overall associations were significant in restricted cubic spline analyses, without evidence of nonlinearity. Among individual indices, AIP-BMI had the largest apparent AUC (83.05%, sensitivity 81%, specificity 80%), followed by AIP-WC (81.32%) and AIP (78.66%). The AIP + AIP-BMI model had the largest apparent AUC among evaluated models (84.19%, sensitivity 81%, specificity 81%). Results remained broadly consistent in sensitivity analyses excluding participants with NAFLD, whereas subgroup analyses were underpowered to detect interactions.
First-trimester AIP, AIP-BMI, and AIP-WC were associated with subsequent GDM, and AIP-BMI showed higher apparent discrimination than AIP alone in this sample. These findings require confirmation in larger cohorts with directly measured anthropometry and appropriate internal and external validation.