Trimester-specific association of gestational Atherogenic Index of Plasma (AIP) with adverse pregnancy outcomes among women with and without GDM: a cohort study

Atherogenic Index of Plasma (AIP) is a well-recognized marker for cardiovascular disease (CVD), however, its impact on adverse pregnancy outcomes (APOs) has been rarely explored, with particular uncertainty about whether the associations differ between women with and without gestational diabetes mellitus (GDM). Pregnant women were recruited between 24 and 28 gestational weeks at Ma’anshan maternal and child health care center (Anhui Province, China) from June 2021 to December 2022. AIP values were calculated for 862 participants during both the second and the third trimester, using blood lipid data extracted from the electronic medical records. Selected APOs included preterm birth (PTB), low birth weight (LBW), and macrosomia. Logistic regression was performed to examine the association of AIP with selected APOs—both in full sample and stratified by GDM diagnosis status. Receiver operating characteristic (ROC) curves were used to illustrate the predictive ability of AIP values and individual lipid indicators for selected APOs. Associations of AIP with selected APOs were observed in the non-GDM group but not in the GDM group and were more pronounced in the third pregnancy: In the second-trimester, lower AIP levels were significantly associated with an increased risk of PTB (OR = 3.234; 95%CI: 1.018 to 10.275; P=0.047); In the third trimester, lower AIP was correlated with higher risks of both PTB (OR = 4.866; 95%CI: 1.583 to 14.955; P ༝0.006) and LBW (OR = 4.939; 95%CI:1.227 to 19.883; P༝0.025). Meanwhile, elevated AIP was linked to an increased incidence of macrosomia (OR = 3.344; 95%CI: 1.457 to 7.677; P༝0.004). Similarly, predictive performance varied between GDM and non-GDM groups. In the non-GDM group, the third trimester indicators showed the highest AUC values for the respective outcomes (TG for PTB, AUC = 0.656; AIP for macrosomia, AUC = 0.652; HDL-C for LBW, AUC = 0.722). In the GDM group, HDL-C yielded the highest AUC values (AUC were 0.668, 0.705, and 0.764 for PTB, macrosomia and LBW, respectively). AIP showed associations with selected APOs in the non-GDM group and the third-trimester AIP showed the highest AUC for macrosomia in this group; HDL-C was associated with the highest AUC values across all three selected APOs (PTB, macrosomia, and LBW) in the GDM group. Not applicable.