International Journal of Gynaecology and Obstetrics · Oct 19, 2026
Association between atherogenic index of plasma at 11-20 weeks of gestation and gestational diabetes risk: A prospective cohort study in China
By Kong M, Zhong C, Gao Q et al.
BACKGROUND: Recent studies have linked insulin resistance and the onset of type 2 diabetes mellitus to the atherogenic index of plasma (AIP). This integrated lipid marker reflects cardiovascular risk and atherogenic dyslipidemia. However, its relationship with gestational diabetes mellitus (GDM) is not completely understood. This study aimed to evaluate the association between AIP measured at 11-20 weeks of gestation and the subsequent risk of GDM and to identify the optimal AIP threshold for GDM prediction. METHODS: A total of 2068 women with singleton pregnancies were included in this prospective cohort study from the Tongji Maternal and Child Health Cohort. AIP was calculated from fasting triglycerides and high-density lipoprotein cholesterol (HDL-C) measurements obtained at 11-20 weeks of gestation, before GDM diagnosis by 75-g oral glucose tolerance test at 24-28 weeks of gestation. Subgroup analysis, restricted cubic spline models, and multivariable logistic regression were used to assess the relationship between GDM and AIP. The predictive performance of AIP alone and in combination with maternal age, pre-pregnancy body mass index (BMI), and low-density lipoprotein cholesterol (LDL-C) was compared via receiver operating characteristic curve analysis. RESULTS: Gestational diabetes mellitus was diagnosed in 252 participants (12.3%). Women in the highest AIP quartile demonstrated a substantially higher risk than those in the lowest quartile (adjusted odds ratio 2.56; 95% confidence interval (CI) 1.63-4.01; P < 0.001), and higher AIP levels were associated with a progressively higher risk of GDM. AIP and GDM risk were found to be significantly positively correlated (P for overall association <0.001), with no statistically significant evidence of nonlinearity (P for nonlinearity = 0.700), as assessed by restricted cubic spline analysis. Based on the maximum Youden index, an AIP value equal to 0.091 was determined to be the ideal cut-off for GDM prediction. A multivariable model incorporating AIP, pre-pregnancy BMI, maternal age, and LDL-C showed improved discriminative ability compared with AIP alone (area under the curve 0.69; 95% CI 0.66-0.73). CONCLUSION: Elevated AIP levels at 11-20 weeks of gestation were independently associated with an increased risk of GDM. Importantly, the inclusion of AIP alongside established maternal risk factors enhanced predictive accuracy. The findings of this study indicate that AIP might serve as a useful adjunctive biomarker in early antenatal screening to identify women at heightened risk for GDM.