Comparison of triglyceride-glucose index and its derived indices as markers for adverse pregnancy outcomes

doi:10.4239/wjd.v17.i5.117022

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May 15, 2026 (publication date) through May 14, 2026

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Diabetes. May 15, 2026; 17(5): 117022
Published online May 15, 2026. doi: 10.4239/wjd.v17.i5.117022

Comparison of triglyceride-glucose index and its derived indices as markers for adverse pregnancy outcomes

Shu-Yu Li, Mei-Mei Hu, Lan-Lan Xiang, Yi-Tian Zhu, Yun Liu, Yi-Ting Chen, Ya-Jun Chen, Yu Zeng, Tian-Ying Zhong

Shu-Yu Li, Mei-Mei Hu, Lan-Lan Xiang, Yi-Tian Zhu, Yun Liu, Yi-Ting Chen, Ya-Jun Chen, Yu Zeng, Tian-Ying Zhong, Department of Clinical Laboratory, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, Nanjing 210002, Jiangsu Province, China

Co-first authors: Shu-Yu Li and Mei-Mei Hu.

Co-corresponding authors: Yu Zeng and Tian-Ying Zhong.

Author contributions: Li SY and Hu MM designed the research plan, analyzed the data, participated in discussions, drafted the initial manuscript, and reviewed the manuscript; Xiang LL, Zhu YT and Liu Y analyzed the data, contributed to data presentation, and participated in revising the manuscript; Chen YT and Chen YJ participated in the discussion and provided further editing and comments; Li SY and Hu MM contributed equally to this work as co-first authors. Zeng Y and Zhong TY critically revised the manuscript and approved the final version. They contributed equally as co-corresponding authors. All authors approved the final version. Zeng Y and Zhong TY contributed equally to this work, due to their distinct yet complementary contributions essential to this multidisciplinary study. Zhong TY served as the principal investigator of the clinical cohort. She was responsible for the study design, the ethical approval process, and the rigorous oversight of clinical data collection, ensuring the integrity of the pregnancy outcome records. On the other hand, Zeng Y led the statistical analysis and the metabolic interpretation of the study. She was responsible for the calculation of the triglyceride-glucose derived indices, the advanced regression modeling, and the drafting of the manuscript's discussion regarding lipid metabolism mechanisms. Given that this research bridges clinical obstetrics with metabolic data science, the specific expertise of both authors was equally critical. Neither author could have completed the project independently without the other’s specialized leadership. Therefore, we believe designating them as co-corresponding authors best reflects their equal intellectual input and responsibility for this work.

Supported by Nanjing Medical Science and Technique Development Foundation, No. YKK23151; the Opening Foundation of Key Laboratory, No. JSHD202313; Yingke Xinchuang Research Foundation of Jiangsu Blood Transfusion Association, No. JSYK2024006; and Open Project of the State Key Laboratory of Reproductive Medicine of Nanjing Medical University, No. SKLRM-K202107.

Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital (No. 2022KY-123).

Informed consent statement: Considering that this study was retrospective and that the data did not contain any personally identifiable data, the Medical Ethics Committee of Nanjing Women and Children’s Healthcare Hospital determined that the requirement for informed consent from participants was not applicable.

Conflict-of-interest statement: The authors declare that they have no conflicts of interest. Furthermore, there are no conflicts of interest between the funder and the authors.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data that support the findings of this study are available from the corresponding author Yu Zeng upon reasonable request.

Corresponding author: Tian-Ying Zhong, Professor, Department of Clinical Laboratory, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, No. 123 Tianfei Alley, Mochou Road, Nanjing 210002, Jiangsu Province, China. zhongtianying@njmu.edu.cn

Received: November 26, 2025
Revised: January 25, 2026
Accepted: March 16, 2026
Published online: May 15, 2026
Processing time: 165 Days and 20.7 Hours

Abstract

BACKGROUND

Insulin resistance (IR) and obesity are key risk factors for adverse pregnancy outcomes (APOs). While the triglyceride-glucose (TyG) index is a reliable surrogate for IR, its independent predictive utility during pregnancy may be limited. Consequently, novel composite indices combining the TyG index with obesity metrics have been proposed. However, a systematic comparison of their predictive performance for APOs is currently lacking.

AIM

To compare the predictive performance of the TyG index and its derived indices for APOs.

METHODS

A retrospective cohort study included 10422 pregnant women from Eastern China. The TyG index was calculated using fasting triglycerides and glucose. The TyG-derived indices were computed by integrating TyG with body mass index (BMI), waist circumference and waist-to-height ratio (WHtR). Logistic regression, restricted cubic spline (RCS) models, and receiver operating characteristic (ROC) analyses were utilized to evaluate associations and predictive performance. Subgroup analyses stratified by maternal age and pre-pregnancy BMI were conducted to assess consistency.

RESULTS

Higher levels of TyG and its derivatives were independently associated with increased risks of gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), cesarean delivery (CD), large for gestational age (LGA) (all P for trend < 0.05). After adjustment, TyG-BMI showed the strongest association with HDP [odds ratio (OR) = 1.46, 95% confidence interval (CI): 1.14-1.87] and LGA (OR = 3.28, 95%CI: 2.75-3.91) when comparing the top vs bottom tertile. RCS analysis revealed primarily linear associations, with non-linear trends observed for LGA. ROC analysis indicated that all derived indices demonstrated superior performance over the TyG index alone in predicting HDP, CD, and LGA, while TyG-WHtR provided a marginal improvement in GDM prediction. The robustness of the findings was validated through additional subgroup analyses.

CONCLUSION

Both TyG and its derived indices are valuable markers for the early prediction of APOs. Among these, TyG-BMI may represent a promising indicator for identifying the high-risk population.

Keywords: Triglyceride-glucose index; Derived triglyceride-glucose indices; Insulin resistance; Maternal obesity; Adverse pregnancy outcomes

Core Tip: This study demonstrates that integrating obesity metrics with the triglyceride-glucose (TyG) index significantly enhances the prediction of adverse pregnancy outcomes. The derived indices, particularly TyG-body mass index (TyG-BMI), showed superior predictive performance for hypertensive disorders of pregnancy, cesarean delivery, and large-for-gestational-age infants compared to the TyG index alone. These findings highlight that simple, cost-effective composite indices like TyG-BMI can serve as useful tools for early identification of high-risk pregnancies, offering significant clinical value.