Relationship Between TyG Index,HCY And MTHFR C667T Gene Polymorphism And Gestational Diabetes Mellitus And Adverse Pregnancy Outcomes

Objective:As a relatively common metabolic disease during pregnancy,gestational diabetes mellitus(GDM)not only leads to perinatal adverse pregnancy outcomes,but also increases the risk of long-term chronic metabolic diseases for mother and child.The important pathophysiological features that lead to the disorder of glucose and lipid metabolism in GDM patients are the decreased Insulin sensitivity and Insulin Resistance(IR)during pregnancy.In addition,a large number of studies showed that the interaction between genetic,environmental and nutritional factors could increase the risk of GDM.The triglyceride-glucose(TyG)index,as an indicator that could reflect the IR level of the body,was of certain predictive value for evaluating insulin sensitivity.The study found that homocysteine(HCY)levels for methylene four hydrogen folic acid reductase(MTHFR)thymine bases on the 677th locus mutation,IR,blood lipid and glucose metabolism disorders,Is associated with GDM and pregnancy-related adverse maternal and maternal outcomes.At present,there are few studies on the correlation between MTHFR C667T,HCY and IR in GDM patients.This study mainly analyzed the correlation between MTHFR C667T gene polymorphism,multiple screening indicators in the second trimester and the risk of GDM and adverse pregnancy outcomes.In order to investigate the potential effects of different serum markers in the second trimester on adverse pregnancy outcomes of GDM,and to provide evidence for improving the prognosis.Methods:A total of 859 pregnant women who received regular obstetrical examination and hospitalized delivery in Hebei General Hospital from October 2020 to June 2022 were retrospectively analyzed.According to the results of 75g oral glucose tolerance test(75g OGTT),the patients were divided into GDM group(n=476,55.4%)and control group(n=383,44.6%).Adverse pregnancy outcomes were defined as preterm birth,gestational hypertension,macrosomia,premature rupture of membranes,hyperamniotic fluid,fetal distress,neonatal hypoglycemia,neonatal transfer to the intensive care unit(NICU),puerperal infection,and postpartum hemorrhage.According to the above adverse pregnancy outcome indexes,GDM patients were divided into A1 group(n=223)and A2 group(n=253)with good outcome.After normality test,the analysis data met the normal distribution T-test and did not meet the normal distribution rank sum test.Chi-square test was used for categorical variables.Spearman test and multiple linear regression were used for correlation analysis.Binary Logistic regression analysis was used for multivariate analysis.Receiver operating characteristic curve(ROC)was used and the Area under the cure(AUC)was calculated to compare the predictive value of all indicators and combined indicators in patients with GDM.Results:1.Comparison of general data between the GDM group and the healthy control group showed that age,progestational BMI,TyG index,FPG,HbA1c,HCY,TG and TC in the GDM group were higher than those in the control group,while HDL was lower than that in the control group(P<0.05).The distribution frequency of CC gene,CT gene and C allele in GDM group was lower than that in control group,while the distribution frequency of TT gene and T allele was significantly higher than that in control group(P<0.05).2.Spearman correlation analysis showed that TyG index was positively correlated with age,progestational BMI,HCY,HbAlc and TC(P<0.001).There was no correlation with HDL(P>0.05).Multiple linear regression analysis showed no correlation between TyG index and MTHFR C677T gene polymorphism(P>0.05).3.Logistic regression analysis showed that after adjusting for age,progestational BMI,HbAlc,TyG and HCY,pure MTHFR C677T gene and mutated TT gene were independent risk factors for GDM.TyG index,HbA1c,HCY,age and progestational BMI were all independent risk factors for GDM.Combining HbA1c,TyG index and HCY to predict the model equation,Hosmer-Lemeshow test χ2=13.113,P=0.108,indicating a good fit of the model.4.ROC curve analysis showed that the AUC of TyG index was 0.652,that of HCY was 0.728,and that of HbA1c was:0.783,and the AUC of the three combined prediction models:0.840,suggesting that TyG index,HCY and HbA1c have better predictive ability for patients with GDM,and the combined prediction value of the three is higher.5.Compared with GDM,HCY,TyG index,FPG,TG,SBP and DBP in group A1 were higher than those in group A2,with statistical significance(P<0.05).6.Logistic regression analysis showed that HCY,TyG index and SBP were risk factors for adverse pregnancy outcomes in GDM patients(P<0.05).Conclusion:1.Pure and mutated TT gene of MTHFR C677T,TyG index,HbA1c and HCY were independent risk factors for GDM.2.The combination of HbA1c,TyG index and HCY has good predictive value for patients with GDM.3.HCY,TyG index and SBP were risk factors for adverse pregnancy outcomes in GDM patients.