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Life sciences · Journal article
BMC Pregnancy and Childbirth · October 1, 2026
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Abstract Background Mitigating adverse maternal-fetal outcomes in gestational diabetes mellitus (GDM), particularly its mixed phenotype (GDM-Mixed, characterized by concurrent fasting and post-load hyperglycemia reflecting both severe insulin resistance and β-cell secretory dysfunction), remains a critical clinical challenge. Confounded by gestational physiological hyperlipidemia, conventional single or composite lipid indices (e.g.,triglyceride-glucose index (TyG) and Triglyceride-glucose body mass index (TyG-BMI)) are limited in comprehensively evaluating maternal glucolipid metabolism and lipid clearance.Hence, this study evaluated the potential of triglyceride-high-density cholesterol-glucose body mass index (TyHGB)—an index integrating body mass index with key glucolipid metabolic parameters—in assessing GDM and mixed GDM. By systematically comparing TyHGB with TyG and TyG-BMI, we aimed to evaluate its potential for early-pregnancy risk stratification in high-risk populations. Methods Utilizing the Health Early Life Birth Cohort (HELBC), this retrospective study applied multivariable logistic regression and restricted cubic splines to evaluate the association and dose-response relationships of TyHGB with GDM/mixed GDM. Multicollinearity was ruled out via variance inflation factors ( VIF ). Diagnostic accuracy and model stability were assessed using ROC curves with DeLong tests and stratified 10-fold cross-validation, comparing TyHGB against TyG and TyG-BMI. Subgroup, interaction, and E-value sensitivity analyses verified the stability and robustness of our findings. Results First-trimester TyHGB was independently associated with GDM and GDM-Mixed risks (both P < 0.001), with per-unit increment OR s of 3.26 (95% CI: 2.20–4.94) and 8.98 (4.00–22.00). TyHGB predicted GDM with an AUC of 0.798, outperforming TyG (0.761, P = 0.023) and TyG-BMI (0.721, P < 0.001). For GDM-Mixed, TyHGB achieved an AUC of 0.924, comparable to TyG ( P = 0.465). A significant interaction occurred with pre-pregnancy BMI ( P interaction = 0.030), showing a stronger association in non-obese women (a OR = 4.15). Conclusion First-trimester TyHGB index is independently associated with an increased risk of GDM and mixed GDM, exhibiting superior predictive performance over traditional glucolipidic indices in our cohort. Given its significant interaction with pre-pregnancy BMI, TyHGB may serve as a complementary screening tool to assess latent glucolipidic metabolic disorders in non-obese pregnant women.