脂质蓄积指数与妊娠期糖尿病的关系及对妊娠结局的预测价值分析OA

Objective To investigate the predictive value of the lipid accumulation product(LAP)in early pregnancy for adverse pregnancy outcomes and to explore the mediating mechanisms through glucose metabolism indicators.Methods A prospective study enrolled 316 pregnant women in early pregnancy(6-12+6 weeks of gestation)who established prenatal care and underwent routine antenatal examinations at the Obstetrics Clinic of Leshan Maternal and Child Health Hospital between January 2022 and November 2024.Baseline data including pre-pregnancy body mass index(BMI),waist circumference,and triglyceride(TG)levels were collected to calculate LAP,and pregnancy outcomes were followed up until delivery.Participants were divided into the adverse pregnancy outcome group(n=114)and the normal pregnancy outcome group(n=202)according to the occurrence of adverse pregnancy outcomes.General characteristics and early pregnancy laboratory serological indicators were compared between the two groups.Logistic regression analysis was performed to assess the independent association between early pregnancy LAP and pregnancy outcomes.Multivariable regression analyses were conducted to examine the associations between early pregnancy LAP and glucose metabolism related indicators.Restricted cubic spline models were used to evaluate the dose-response relationship between early pregnancy LAP and pregnancy outcomes.Mediation effect models were constructed to analyze the effects of early pregnancy LAP and glucose metabolism indicators on pregnancy outcomes.Results Compared with the normal pregnancy group,women in the adverse pregnancy outcome group had significantly higher early pregnancy LAP,fasting plasma glucose(FPG),prevalence of gestational diabetes mellitus(GDM),glycated hemoglobin(HbA1c),fasting insulin(FINS),and log transformed homeostasis model assessment of insulin resistance(HOMA-IR)(χ2/t ranging from 4.974 to 35.889,P<0.05),whereas log transformed homeostasis model assessment of β-cell function(HOMA-β)was significantly lower(t=-4.078,P<0.05).Logistic regression analysis showed that early pregnancy LAP was independently associated with pregnancy outcomes(OR=1.553,95%CI:1.296-2.617,P<0.05),and a significant trend was observed across increasing LAP quintiles(Pfor trend<0.05).Multivariable regression analyses indicated that early pregnancy LAP was an independent predictor of increased FPG,HbA1c,FINS,and log HOMA-IR(β<0),decreased log HOMA-β(β<0),and elevated risk of GDM(P<0.05).FPG,HbA1c,FINS,log HOMA-IR,and log HOMA-β mediated 16.30%,12.45%,15.61%,12.29%,and 11.75%,respectively,of the association between early pregnancy LAP and pregnancy outcomes,indicating partial mediation effects.Conclusion The LAP in early pregnancy not only directly increases the risk of adverse pregnancy outcomes but also indirectly affects pregnancy outcomes by elevating blood glucose levels,exacerbating insulin resistance,and increasing the risk of GDM,making it an important early predictive marker for adverse pregnancy outcomes.