Association of the triglyceride-glucose index and the ratio of triglyceride to high-density lipoprotein cholesterol with fetal macrosomia in nulliparous pregnant women: a prospective case-control study.

Abstract

Objective: We aimed to investigate the association between the triglyceride-glucose index (TyG index) and the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) with fetal macrosomia in nulliparous pregnant women.

Design: A prospective case-control study.

Setting: Ankara Etlik Zubeyde Hanim Maternal's Health Education and Training Hospital.

Population: Nulliparous singleton pregnant women.

Methods: A prospective case-control study was conducted from January 2023 to June 2024.

Main outcome measure: Demonstrating the relationship between the TyG index and the TG/HDL-C with fetal macrosomia.

Results: In all, 302 nulliparous singleton pregnant women were grouped into a study group (n = 151) and a control group (n = 151). Pregnant women who had a higher TyG index and TG/HDL-C valıue had a significantly higher incidence of fetal macrosomia. The optimal sensitivity/specificity value for the TG/HDL-C to detect macrosomic fetus was > 3,63, which is the cut-off value for using the TG/HDL-C at a specificity of 89% and a sensitivity of 83% with the best area under the curve of 0,927 and a 95% confidence interval of 0,892-0,954. For the TyG index, the other main parameter of the present study, a cut-off point of > 4,88 was optimal, with a sensitivity of 0,76 and a specificity of 0,78 at this cut-off point. However, no differences were observed in maternal age, body mass index, gravidity, history of abortion, smoking status and working status.

Conclusion: A higher TyG index and a higher TG/HDL-C ratio in maternal blood in late gestation indicate a metabolic process that causes fetal macrosomia. The cut-off value for the TyG index (> 4.88) at 78% specificity and a cut-off value for the TG/HDL-C ratio (> 3,63) at 89% specificity can be used as a predictive test. Physicians should be more cautious about the risk of macrosomic fetuses when these values of the current test results are available. The limitation of this study, however, was that it only concerned a single center.

Trial registration: The trial is registered at www.clinicaltrails.gov [registration number: NCT06463990; registration date: 01/June/2024 (retrospectively registered)].