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Objective To evaluate the association of hepatic steatosis index (HSI) in the first trimester and the risk of gestational diabetes mellitus (GDM) as well as large for gestational age (LGA) infant in Chinese women. Methods A total of 1082 pregnant women were included in this study. Maternal basic laboratory data, including ALT, AST, FBG, insulin, TG, and HDL-C, were tested during 6–12 weeks of gestation and anthropometric characteristics were monitored during gestation. A 75-g oral glucose tolerance test (OGTT) was conducted at 24–28 weeks of gestation. HSI, nonalcoholic fatty liver disease (NAFLD) liver fat score, triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) and triglyceride-glucose (TyG) index were calculated. Odds ratio with 95% confidence interval for subsequent risk of GDM and LGA by HSI quartiles were assessed by binary logistic regression model. The predictive ability of HSI for GDM and LGA was evaluated by the receiver operating characteristic (ROC) curve analysis and was compared with other indices. Results The incidence of GDM and LGA were 22.09% (239/1082) and 10.53% (87/826). HSI was higher in GDM group than in NGT group (median, interquartile range: 30.67, 27.20–35.10 vs 27.98, 25.70–30.82, P <0.001). Incidence of GDM was gradually increased with increasing HSI values. Women in the highest HSI quartile had significantly higher risk of LGA delivery than those in the lowest HSI quartile ( P <0.05). The area under the ROC curves of HSI for GDM and LGA were higher than other indices, reaching 0.646 (95%CI: 0.605–0.686) and 0.600 (95%CI: 0.541–0.660), respectively. Conclusion Higher HSI was independently associated with higher risk of GDM and LGA in Chinese women. HSI in the first trimester can predict the risk of GDM and LGA.

Objective To assess the association between insulin resistance and gestational diabetes mellitus (GDM) in early pregnancy and find a simple surrogate index of the homeostasis model assessment of insulin resistance (HOMA‐IR). Methods A total of 700 pregnant women were included in this prospective, double‐center, observational cohort study. The glucose and lipid metabolic characterization was performed at 6–12 weeks of pregnancy. All participants underwent a 75‐g oral glucose tolerance test at 24–28 weeks of pregnancy. Linear regression analysis was applied to find a novel surrogate index of HOMA‐IR. Binary logistic analysis was applied to estimate possible associations of different indices with GDM and insulin resistance. Results GDM was diagnosed in 145 of 700 women with singleton pregnancies (20.7%). HOMA‐IR was higher in the GDM group than in the normal glucose tolerance (NGT) group and was an individual risk factor for GDM (adjusted risk ratio RR 1.371, 95% confidence interval [CI] 1.129–1.665, P < 0.001). TyHGB index as the surrogate index of HOMA‐IR was represented as TG/HDL‐C + 0.7*FBG (mmol/L) +0.1*preBMI (kg/m2)(where TG/HDL‐C is triglyceride/high‐density lipoprotein cholesterol; FBG is fasting blood glucose, and preBMI is the pre‐pregnancy body mass index [calculated as weight in kilograms divided by the square of height in meters]). The cut‐off point of the TyHGB index was 6.0 (area under the curve 0.827, 95% CI 0.794–0.861, P < 0.001) for mild insulin resistance. Conclusion Increased HOMA‐IR in early pregnancy was a risk factor of GDM. TyHGB index could be a surrogate index of HOMA‐IR and had a predictive value for GDM.