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Background <p>Remnant cholesterol (RC), representing the cholesterol content of triglyceride-rich lipoproteins, has emerged as an essential metabolic risk marker. However, evidence regarding the association between mid-pregnancy RC levels and adverse pregnancy-related outcomes (APO) among women with gestational diabetes mellitus (GDM) remains limited.</p> Methods <p>This retrospective cohort study included 823 singleton pregnant women diagnosed with GDM who received routine antenatal care at Hangzhou Women’s Hospital between January 2023 and July 2024. Fasting serum lipid profiles were measured at 24–28 gestational weeks. RC was categorized into quartiles (Q1-Q4). The primary outcome was a composite APO, including placental abruption, premature rupture of membranes, oligohydramnios or polyhydramnios, postpartum hemorrhage, shoulder dystocia, preterm birth (&lt; 37 weeks), stillbirth, fetal distress, fetal malformations, and fetal growth restriction. Multivariable logistic regression models were used to evaluate the association between RC quartiles and APO. Restricted cubic spline (RCS), receiver operating characteristic (ROC) curve, subgroup analyses, and sensitivity analyses were conducted to assess robustness.</p> Results <p>The overall incidence of APO was 33.9%. After adjustment for age, pre-pregnancy BMI, FPG, 2&#xa0;h-PG, nulliparous, prior abortion, conceived by IVF, antenatal comorbidities, and laboratory parameters (MO, LY, PLT, ALT), the highest RC quartile was significantly associated with increased risk of APO (adjusted OR = 5.75, 95% CI: 3.60–9.18; <i>P</i> &lt; 0.001). RCS analysis demonstrated a linear dose–response relationship between RC and APO risk (non-linearity <i>P</i> = 0.239). The area under the ROC curve for RC was 0.676, higher than those of conventional lipid parameters. Category-specific analyses showed more consistent associations for fetal and obstetric APO, whereas placental APO showed a weaker association. These associations were generally consistent across subgroups and sensitivity analyses.</p> Conclusions <p>Elevated mid-pregnancy fasting RC levels were independently associated with a higher risk of APO among women with GDM. RC may serve as a clinically relevant lipid-related marker for risk stratification during pregnancy.</p>

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Association of mid-pregnancy remnant cholesterol levels with adverse pregnancy outcomes in women with gestational diabetes mellitus

  • 期刊论文

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  • 发表日期：

    2026年4月9日

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  • Yufei Fan,
  • Yanfei Lu,
  • Xiaoqing Fan,
  • Yingying Wu,
  • Yuan Wang

摘要

Background

Remnant cholesterol (RC), representing the cholesterol content of triglyceride-rich lipoproteins, has emerged as an essential metabolic risk marker. However, evidence regarding the association between mid-pregnancy RC levels and adverse pregnancy-related outcomes (APO) among women with gestational diabetes mellitus (GDM) remains limited.

Methods

This retrospective cohort study included 823 singleton pregnant women diagnosed with GDM who received routine antenatal care at Hangzhou Women’s Hospital between January 2023 and July 2024. Fasting serum lipid profiles were measured at 24–28 gestational weeks. RC was categorized into quartiles (Q1-Q4). The primary outcome was a composite APO, including placental abruption, premature rupture of membranes, oligohydramnios or polyhydramnios, postpartum hemorrhage, shoulder dystocia, preterm birth (< 37 weeks), stillbirth, fetal distress, fetal malformations, and fetal growth restriction. Multivariable logistic regression models were used to evaluate the association between RC quartiles and APO. Restricted cubic spline (RCS), receiver operating characteristic (ROC) curve, subgroup analyses, and sensitivity analyses were conducted to assess robustness.

Results

The overall incidence of APO was 33.9%. After adjustment for age, pre-pregnancy BMI, FPG, 2 h-PG, nulliparous, prior abortion, conceived by IVF, antenatal comorbidities, and laboratory parameters (MO, LY, PLT, ALT), the highest RC quartile was significantly associated with increased risk of APO (adjusted OR = 5.75, 95% CI: 3.60–9.18; P < 0.001). RCS analysis demonstrated a linear dose–response relationship between RC and APO risk (non-linearity P = 0.239). The area under the ROC curve for RC was 0.676, higher than those of conventional lipid parameters. Category-specific analyses showed more consistent associations for fetal and obstetric APO, whereas placental APO showed a weaker association. These associations were generally consistent across subgroups and sensitivity analyses.

Conclusions

Elevated mid-pregnancy fasting RC levels were independently associated with a higher risk of APO among women with GDM. RC may serve as a clinically relevant lipid-related marker for risk stratification during pregnancy.