Association between non-fasting triglyceride-glucose index in the third trimester and macrosomia in pregnant women at high altitude

doi:10.3877/cma.j.issn.2095-3259.2026.03.006

Abstract

Abstract:

Objective

To investigate the relationship between the non-fasting triglyceride-glucose (TyG) index and macrosomia during the third trimester in pregnant women at high altitudes.

Methods

A retrospective study was conducted on singleton pregnant women who delivered at Chaya People's Hospital of Qamdo City, Xizang Autonomous Region, from January 2023 to April 2025. Participants were divided into a macrosomia group and a control group based on newborn birth weight. The non-fasting TyG index was calculated from non-fasting triglyceride (TG) and random plasma glucose (PG). Based on the tertiles of the non-fasting TyG index, participants were divided into three groups. The baseline clinical characteristics, lipid profiles, and the risk of macrosomia were compared among the three groups. Statistical analyses were performed using one-way ANOVA, Kruskal-Wallis H test, Chi-square test, or Fisher's exact test for multi-group comparisons. Multivariate logistic regression and restricted cubic spline (RCS) analyses were used to evaluate the correlation between the non-fasting TyG index and macrosomia. Subgroup analyses were also conducted.

Results

(1) A total of 771 singleton pregnant women were included, with a mean age of 27.3±6.1 years, a proportion of 26.72% (206/771) primiparous women, a pre-pregnancy BMI of (25.1±2.3) kg/m^2, and a mean non-fasting TyG index of 9.1±0.4. Twenty-one pregnant women were diagnosed with macrosomia, with a detection rate of 2.72% (21/771). (2) Statistically significant differences in pre-pregnancy BMI, altitude, serum total cholesterol (TC), TG, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), PG, newborn birth weight, and the incidence of macrosomia were observed among the three non-fasting TyG groups (all P<0.05). Trend tests further revealed that TC, TG, LDL-C, PG, newborn birth weight, and macrosomia incidence all showed increasing trends with the elevation of the non-fasting TyG index (all P<0.001). (3) Multivariate logistic regression analysis demonstrated an independent positive association between the non-fasting TyG index and macrosomia (OR=6.64, 95%CI: 2.00-22.01, P=0.002), and the risk of macrosomia increased progressively with the non-fasting TyG index (P for trend <0.05). (4) Restricted cubic spline analysis showed a linear dose-response relationship between the non-fasting TyG index and macrosomia (P for non-linearity =0.355). (5) Subgroup analysis revealed no interaction between the non-fasting TyG index and hyperglycemia in pregnancy (HIP) in relation to macrosomia (P for interaction >0.05).

Conclusions

The non-fasting TyG index in the third trimester is an independent risk factor for macrosomia in singleton pregnant women at high altitudes, and the risk of macrosomia increases progressively with the elevation of the non-fasting TyG index.

Key words: High altitude, Pregnancy trimester, third, Non-fasting triglyceride-glucose index, Fetal macrosomia

Qingqing Wang, Qiufeng Wang, Ma Ni, Yating Liang, Xiaoyu Chen, Qiang Liu, Hongying Hou, Zhenyan Han. Association between non-fasting triglyceride-glucose index in the third trimester and macrosomia in pregnant women at high altitude[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2026, 15(03): 158-166.

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References 43

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分组	例数	年龄(岁，±s)	孕次[次，M(P₂₅，P₇₅)]	产次[次，M(P₂₅，P₇₅)]	分娩前体重指数(kg/m²，±s)	收缩压(mmHg，±s)	舒张压(mmHg，±s)	海拔高度(m，±s)
Q1组	257	26.9±6.1	2.0(2.0, 4.0)	1.0(1.0, 3.0)	25.0±2.2	121.5±13.1	78.3±9.9	3931.7±311.8
Q2组	257	27.0±6.2	2.0(1.0, 3.0)	1.0(0.0, 2.0)	24.9±2.2	122.9±14.1	80.0±10.3	3939.0±336.7
Q3组	257	27.8±6.1	2.0(1.0, 3.0)	1.0(0.0, 2.0)	25.4±2.5	123.4±14.7	81.3±10.7	3851.3±384.5
统计值		t＝1.682	Z＝3.71	Z＝4.532	t＝3.267	t＝1.212	t＝5.399	t＝5.088
P值		0.187	0.156	0.104	0.039	0.298	0.005	0.006
分组	例数	总胆固醇(mmol/L，±s)	甘油三酯(mmol/L，±s)	高密度脂蛋白胆固醇(mmol/L，±s)	低密度脂蛋白胆固醇(mmol/L，±s)	血糖(mmol/L，±s)	非空腹TyG(±s)	糖化血红蛋白(%，±s)
Q1组	257	5.5±0.9	1.7±0.4	2.1±0.4	3.2±0.8	4.2±0.7	8.6±0.2	4.6±0.4
Q2组	257	6.0±1.0	2.4±0.4	2.0±0.5	3.6±0.9	4.6±0.7	9.0±0.1	4.6±0.4
Q3组	257	6.4±1.2	3.4±0.9	2.0±0.5	4.1±1.1	5.2±1.0	9.5±0.2	4.7±0.5
统计值		t＝47.337	t＝534.071	t＝3.762	t＝48.115	t＝99.556	t＝1267.053	t＝1.861
P值		<0.001	<0.001	0.024	<0.001	<0.001	<0.001	0.156
分组	例数	ALT[U/L，M(P₂₅，P₇₅)]	AST[U/L，M(P₂₅，P₇₅)]	γ-GT[U/L，M(P₂₅，P₇₅)]	尿酸(μmmol/L，±s)	肌酐(μmmol/L，±s)	C反应蛋白(mg/L，±s)
Q1组	257	12.9(10.2, 18.3)	17.9(15.2, 22.5)	14.6(10.8, 20.5)	289.4±59.7	53.3±9.3	12.0±17.3
Q2组	257	12.3(9.4, 16.1)	17.2(14.6, 20.5)	14.0(10.2, 21.0)	288.3±62.0	52.4±10.8	11.5±16.5
Q3组	257	11.8(9.1, 15.5)	16.8(13.7, 20.5)	14.5(10.9, 21.2)	310.3±67.5	53.9±10.9	9.6±13.9
统计值		Z＝9.046	Z＝9.463	Z＝1.863	t＝9.852	t＝1.312	t＝1.663
P值		0.011	0.009	0.394	< 0.001	0.27	0.19
分组	例数	TSH[μIU/ml，M(P₂₅，P₇₅)]	FT₃[pg/ml，M(P₂₅，P₇₅)]	FT₄[ng/dL，M(P₂₅，P₇₅)]	新生儿出生体重(g，±s)	妊娠期高血糖[例(%)]	巨大儿[例(%)]
Q1组	257	3.3(1.9, 5.1)	2.0(1.8, 2.1)	1.0(0.9, 1.1)	3 042.5±432.8	7(2.7)	2(0.8)
Q2组	257	3.6(2.4, 5.7)	2.0(1.8, 2.1)	1.0(0.9, 1.1)	3 165.6±408.1	9(3.5)	3(1.2)
Q3组	257	3.7(2.2, 5.9)	1.9(1.8, 2.1)	1.0(0.9, 1.1)	3 261.8±514.7	14(5.4)	16(6.2)
统计值		Z＝5.428	Z＝1.772	Z＝9.536	t＝15.047	χ²＝2.705	χ²＝17.917
P值		0.066	0.412	0.008	<0.001	0.259	<0.001

分组	例数	年龄(岁，±s)	孕次[次，M(P₂₅，P₇₅)]	产次[次，M(P₂₅，P₇₅)]	分娩前体重指数(kg/m²，±s)	收缩压(mmHg，±s)	舒张压(mmHg，±s)	海拔高度(m，±s)
Q1组	257	26.9±6.1	2.0(2.0, 4.0)	1.0(1.0, 3.0)	25.0±2.2	121.5±13.1	78.3±9.9	3931.7±311.8
Q2组	257	27.0±6.2	2.0(1.0, 3.0)	1.0(0.0, 2.0)	24.9±2.2	122.9±14.1	80.0±10.3	3939.0±336.7
Q3组	257	27.8±6.1	2.0(1.0, 3.0)	1.0(0.0, 2.0)	25.4±2.5	123.4±14.7	81.3±10.7	3851.3±384.5
统计值		t＝1.682	Z＝3.71	Z＝4.532	t＝3.267	t＝1.212	t＝5.399	t＝5.088
P值		0.187	0.156	0.104	0.039	0.298	0.005	0.006
分组	例数	总胆固醇(mmol/L，±s)	甘油三酯(mmol/L，±s)	高密度脂蛋白胆固醇(mmol/L，±s)	低密度脂蛋白胆固醇(mmol/L，±s)	血糖(mmol/L，±s)	非空腹TyG(±s)	糖化血红蛋白(%，±s)
Q1组	257	5.5±0.9	1.7±0.4	2.1±0.4	3.2±0.8	4.2±0.7	8.6±0.2	4.6±0.4
Q2组	257	6.0±1.0	2.4±0.4	2.0±0.5	3.6±0.9	4.6±0.7	9.0±0.1	4.6±0.4
Q3组	257	6.4±1.2	3.4±0.9	2.0±0.5	4.1±1.1	5.2±1.0	9.5±0.2	4.7±0.5
统计值		t＝47.337	t＝534.071	t＝3.762	t＝48.115	t＝99.556	t＝1267.053	t＝1.861
P值		<0.001	<0.001	0.024	<0.001	<0.001	<0.001	0.156
分组	例数	ALT[U/L，M(P₂₅，P₇₅)]	AST[U/L，M(P₂₅，P₇₅)]	γ-GT[U/L，M(P₂₅，P₇₅)]	尿酸(μmmol/L，±s)	肌酐(μmmol/L，±s)	C反应蛋白(mg/L，±s)
Q1组	257	12.9(10.2, 18.3)	17.9(15.2, 22.5)	14.6(10.8, 20.5)	289.4±59.7	53.3±9.3	12.0±17.3
Q2组	257	12.3(9.4, 16.1)	17.2(14.6, 20.5)	14.0(10.2, 21.0)	288.3±62.0	52.4±10.8	11.5±16.5
Q3组	257	11.8(9.1, 15.5)	16.8(13.7, 20.5)	14.5(10.9, 21.2)	310.3±67.5	53.9±10.9	9.6±13.9
统计值		Z＝9.046	Z＝9.463	Z＝1.863	t＝9.852	t＝1.312	t＝1.663
P值		0.011	0.009	0.394	< 0.001	0.27	0.19
分组	例数	TSH[μIU/ml，M(P₂₅，P₇₅)]	FT₃[pg/ml，M(P₂₅，P₇₅)]	FT₄[ng/dL，M(P₂₅，P₇₅)]	新生儿出生体重(g，±s)	妊娠期高血糖[例(%)]	巨大儿[例(%)]
Q1组	257	3.3(1.9, 5.1)	2.0(1.8, 2.1)	1.0(0.9, 1.1)	3 042.5±432.8	7(2.7)	2(0.8)
Q2组	257	3.6(2.4, 5.7)	2.0(1.8, 2.1)	1.0(0.9, 1.1)	3 165.6±408.1	9(3.5)	3(1.2)
Q3组	257	3.7(2.2, 5.9)	1.9(1.8, 2.1)	1.0(0.9, 1.1)	3 261.8±514.7	14(5.4)	16(6.2)
统计值		Z＝5.428	Z＝1.772	Z＝9.536	t＝15.047	χ²＝2.705	χ²＝17.917
P值		0.066	0.412	0.008	<0.001	0.259	<0.001

分组	例数	年龄(岁，±s)	孕次[次，M(P₂₅~P₇₅)]	产次[次，M(P₂₅~P₇₅)]	海拔高度(km，±s)	分娩前体重指数(kg/m²，±s)	收缩压(mmHg，±s)	舒张压(mmHg，±s)
对照组	750	27.2±6.0	2.0(1.0，3.0)	1.0(0.0，2.0)	3.911 1±0.344 9	25.1±2.2	122.6±14.1	79.9±10.4
巨大儿组	21	29.1±8.4	3.0(2.0，3.0)	2.0(1.0，2.0)	3.772 4±0.416 7	26.2±4.3	120.7±9.4	78.8±8.0
OR值(95%CI)		1.05(0.98~1.12)	1.08(0.83~1.4)	1.07(0.82~1.39)	0.34(0.11~1.11)	1.18(1.02~1.37)	0.99(0.96~1.02)	0.99(0.95~1.03)
P值		0.156	0.579	0.626	0.073	0.023	0.521	0.638
分组	例数	总胆固醇(mmol/L，±s)	甘油三酯(mmol/L，±s)	高密度脂蛋白胆固醇(mmol/L，±s)	低密度脂蛋白胆固醇(mmol/L，±s)	血糖(mmol/L，±s)	非空腹TyG(±s)	糖化血红蛋白(%，±s)
对照组	750	6.0±1.1	2.5±0.9	2.0±0.4	3.6±1.0	4.7±0.9	9.1±0.4	4.6±0.4
巨大儿组	21	6.5±0.8	3.1±0.8	2.1±0.4	4.0±0.8	5.4±1.5	9.4±0.4	4.7±0.6
OR值(95%CI)		1.45(1.03~2.04)	1.76(1.22~2.55)	1.18(0.45~3.05)	1.34(0.9~1.99)	1.98(1.36~2.88)	8.42(3.04~23.36)	1.66(0.59~4.65)
P值		0.033	0.003	0.74	0.145	<0.001	<0.001	0.334
分组	例数	ALT[U/L，M(P₂₅，P₇₅)]	AST[U/L，M(P₂₅，P₇₅)]	γ－GT[U/L，M(P₂₅，P₇₅)]	尿酸(μmmol/L，±s)	肌酐(μmmol/L，±s)	C反应蛋白(mg/L，±s)
对照组	750	12.3(9.5，16.7)	17.3(14.5，21.6)	14.4(10.7，21.0)	296.4±64.0	53.3±10.4	11.1±16.0
巨大儿组	21	12.1(8.3，14.9)	17.6(14.1，21.6)	13.9(11.3，19.4)	280.3±57.2	50.8±9.6	8.1±14.3
OR值(95%CI)		0.97(0.91~1.04)	0.99(0.95~1.03)	1.00(0.96~1.03)	1.00(0.99~1.00)	0.97(0.93~1.02)	0.98(0.94~1.02)
P值		0.394	0.682	0.845	0.253	0.271	0.401
分组	例数	TSH[μIU/ml，M(P₂₅，P₇₅)]	FT₃[pg/ml，M(P₂₅，P₇₅)]	FT₄[ng/dL，M(P₂₅，P₇₅)]	新生儿出生体重(kg，±s)	妊娠期高血糖[例(%)]
对照组	750	3.5(2.2，5.5)	2.0(1.8，2.1)	1.0(0.9，1.1)	3.13±0.43	28(3.7)
巨大儿组	21	3.5(1.6，5.8)	2.0(1.8，2.2)	1.0(0.9，1.1)	4.19±0.22	2(9.5)
OR值(95%CI)		1.03(0.92~1.16)	1.08(0.26~4.39)	1.77(0.16~19.4)	1.00(0.92~1.09)	2.71(0.6~12.23)
P值		0.585	0.916	0.641	0.972	0.194

分组	例数	年龄(岁，±s)	孕次[次，M(P₂₅~P₇₅)]	产次[次，M(P₂₅~P₇₅)]	海拔高度(km，±s)	分娩前体重指数(kg/m²，±s)	收缩压(mmHg，±s)	舒张压(mmHg，±s)
对照组	750	27.2±6.0	2.0(1.0，3.0)	1.0(0.0，2.0)	3.911 1±0.344 9	25.1±2.2	122.6±14.1	79.9±10.4
巨大儿组	21	29.1±8.4	3.0(2.0，3.0)	2.0(1.0，2.0)	3.772 4±0.416 7	26.2±4.3	120.7±9.4	78.8±8.0
OR值(95%CI)		1.05(0.98~1.12)	1.08(0.83~1.4)	1.07(0.82~1.39)	0.34(0.11~1.11)	1.18(1.02~1.37)	0.99(0.96~1.02)	0.99(0.95~1.03)
P值		0.156	0.579	0.626	0.073	0.023	0.521	0.638
分组	例数	总胆固醇(mmol/L，±s)	甘油三酯(mmol/L，±s)	高密度脂蛋白胆固醇(mmol/L，±s)	低密度脂蛋白胆固醇(mmol/L，±s)	血糖(mmol/L，±s)	非空腹TyG(±s)	糖化血红蛋白(%，±s)
对照组	750	6.0±1.1	2.5±0.9	2.0±0.4	3.6±1.0	4.7±0.9	9.1±0.4	4.6±0.4
巨大儿组	21	6.5±0.8	3.1±0.8	2.1±0.4	4.0±0.8	5.4±1.5	9.4±0.4	4.7±0.6
OR值(95%CI)		1.45(1.03~2.04)	1.76(1.22~2.55)	1.18(0.45~3.05)	1.34(0.9~1.99)	1.98(1.36~2.88)	8.42(3.04~23.36)	1.66(0.59~4.65)
P值		0.033	0.003	0.74	0.145	<0.001	<0.001	0.334
分组	例数	ALT[U/L，M(P₂₅，P₇₅)]	AST[U/L，M(P₂₅，P₇₅)]	γ－GT[U/L，M(P₂₅，P₇₅)]	尿酸(μmmol/L，±s)	肌酐(μmmol/L，±s)	C反应蛋白(mg/L，±s)
对照组	750	12.3(9.5，16.7)	17.3(14.5，21.6)	14.4(10.7，21.0)	296.4±64.0	53.3±10.4	11.1±16.0
巨大儿组	21	12.1(8.3，14.9)	17.6(14.1，21.6)	13.9(11.3，19.4)	280.3±57.2	50.8±9.6	8.1±14.3
OR值(95%CI)		0.97(0.91~1.04)	0.99(0.95~1.03)	1.00(0.96~1.03)	1.00(0.99~1.00)	0.97(0.93~1.02)	0.98(0.94~1.02)
P值		0.394	0.682	0.845	0.253	0.271	0.401
分组	例数	TSH[μIU/ml，M(P₂₅，P₇₅)]	FT₃[pg/ml，M(P₂₅，P₇₅)]	FT₄[ng/dL，M(P₂₅，P₇₅)]	新生儿出生体重(kg，±s)	妊娠期高血糖[例(%)]
对照组	750	3.5(2.2，5.5)	2.0(1.8，2.1)	1.0(0.9，1.1)	3.13±0.43	28(3.7)
巨大儿组	21	3.5(1.6，5.8)	2.0(1.8，2.2)	1.0(0.9，1.1)	4.19±0.22	2(9.5)
OR值(95%CI)		1.03(0.92~1.16)	1.08(0.26~4.39)	1.77(0.16~19.4)	1.00(0.92~1.09)	2.71(0.6~12.23)
P值		0.585	0.916	0.641	0.972	0.194

分组	模型1		模型2		模型3		模型4
分组	原始OR(95%CI)	P值	调整后OR(95%CI)	P值	调整后OR(95%CI)	P值	调整后OR(95%CI)	P值
Q1组	1(Ref)		1(Ref)		1(Ref)		1(Ref)
Q2组	1.51(0.25~9.09)	0.655	1.49(0.25~9.02)	0.664	1.32(0.21~8.12)	0.766	1.24(0.20~7.82)	0.817
Q3组	8.46(1.93~37.2)	0.005	7.77(1.75~34.58)	0.007	6.23(1.31~29.66)	0.022	6.22(1.31~29.58)	0.022
趋势P值	3.57(1.71~7.47)	0.001	3.37(1.60~7.08)	0.001	3.01(1.38~6.59)	0.006	3.07(1.40~6.75)	0.005

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