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已发表论文
妊娠期糖尿病 A1 与健康妊娠的胰岛素抵抗比较研究：采用代谢当量胰岛素抵抗指数（METS-IR）和甘油三酯葡萄糖指数（TyG 指数）进行对比
Authors Jiang H, Shang M, Gao S
Received 3 August 2025
Accepted for publication 14 October 2025
Published 23 October 2025 Volume 2025:17 Pages 3789—3797
DOI https://doi.org/10.2147/IJWH.S557974
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Matteo Frigerio
Hao Jiang,1 Min Shang,1 Songkun Gao2
1Department of Gynecology and Obstetrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
Correspondence: Songkun Gao, Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Dongcheng District, Beijing, People’s Republic of China, Email songkungao@126.com
Purpose: To compare the whole-pregnancy insulin resistance level between women with gestational diabetes mellitus A1 (GDM A1) and healthy pregnant women by means of the METS-IR and the TyG index, and to assess the impact of such resistance on pregnancy outcomes.
Methods: 344 parturients were classified as GDM A1 (n=118) or normal by 75-g oral glucose tolerance test (OGTT) conducted at 24– 28 weeks of gestation. Body mass index (BMI), fasting plasma glucose, triglycerides, and high-density lipoprotein cholesterol were measured in early, mid-, and late pregnancy to calculate METS-IR and TyG index values for each period. Longitudinal changes and early-pregnancy values of METS-IR and TyG were compared between groups and related to obstetric outcomes. Furthermore, mediation analysis was conducted to assess the mediating effect of BMI gain on the relationship between TyG index and METS-IR during pregnancy.
Results: METS-IR indicated that insulin resistance in mid- and late pregnancy was significantly higher in the GDM A1 group than in the control group, while the TyG index showed a similar trend beginning in early pregnancy. However, the magnitude of increase in insulin resistance from early to mid-pregnancy did not differ significantly between the two groups. From mid- to late pregnancy, METS-IR increased more rapidly in the control group than in the GDM A1 group, whereas no significant difference was observed in TyG index changes. Early-pregnancy METS-IR and TyG values were not significantly associated with mode of delivery, neonatal birth weight, or placental weight. Mediation analysis revealed that BMI gain had a significantly greater mediating effect on METS-IR elevation than on TyG increase.
Conclusion: Women with GDM A1 exhibited higher insulin resistance throughout pregnancy compared to healthy controls. Early-pregnancy METS-IR and TyG indices were associated with GDM A1 diagnosis but not with delivery characteristics or fetal parameters. Due to the influence of BMI changes during pregnancy, METS-IR may not be a reliable surrogate marker of insulin resistance in this population.
Keywords: GDM A1, insulin resistance, METS-IR, TyG
1Department of Gynecology and Obstetrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, People’s Republic of China
Correspondence: Songkun Gao, Department of Gynecologic Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Dongcheng District, Beijing, People’s Republic of China, Email songkungao@126.com
Purpose: To compare the whole-pregnancy insulin resistance level between women with gestational diabetes mellitus A1 (GDM A1) and healthy pregnant women by means of the METS-IR and the TyG index, and to assess the impact of such resistance on pregnancy outcomes.
Methods: 344 parturients were classified as GDM A1 (n=118) or normal by 75-g oral glucose tolerance test (OGTT) conducted at 24– 28 weeks of gestation. Body mass index (BMI), fasting plasma glucose, triglycerides, and high-density lipoprotein cholesterol were measured in early, mid-, and late pregnancy to calculate METS-IR and TyG index values for each period. Longitudinal changes and early-pregnancy values of METS-IR and TyG were compared between groups and related to obstetric outcomes. Furthermore, mediation analysis was conducted to assess the mediating effect of BMI gain on the relationship between TyG index and METS-IR during pregnancy.
Results: METS-IR indicated that insulin resistance in mid- and late pregnancy was significantly higher in the GDM A1 group than in the control group, while the TyG index showed a similar trend beginning in early pregnancy. However, the magnitude of increase in insulin resistance from early to mid-pregnancy did not differ significantly between the two groups. From mid- to late pregnancy, METS-IR increased more rapidly in the control group than in the GDM A1 group, whereas no significant difference was observed in TyG index changes. Early-pregnancy METS-IR and TyG values were not significantly associated with mode of delivery, neonatal birth weight, or placental weight. Mediation analysis revealed that BMI gain had a significantly greater mediating effect on METS-IR elevation than on TyG increase.
Conclusion: Women with GDM A1 exhibited higher insulin resistance throughout pregnancy compared to healthy controls. Early-pregnancy METS-IR and TyG indices were associated with GDM A1 diagnosis but not with delivery characteristics or fetal parameters. Due to the influence of BMI changes during pregnancy, METS-IR may not be a reliable surrogate marker of insulin resistance in this population.
Keywords: GDM A1, insulin resistance, METS-IR, TyG