Background: Gestational diabetes mellitus (GDM) affects approximately one in six pregnant women worldwide, imposing a significant health and economic burden. The uric acid to high-density lipoprotein cholesterol ratio (UHR), as a biomarker reflecting metabolic dysfunction, may be utilized to assess the prevalence of developing GDM.
Methods: We calculated the UHR index using data from pregnant women who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020. Subsequently, we conducted in-depth validation through analytical methods including multivariate logistic regression, smooth curve fitting, and subgroup analysis.
Results: The logistic regression model demonstrated a positive correlation between the UHR index and GDM, which remained significant even after adjusting for all confounding variables (Odds Ratio [OR] = 1.16, 95% Confidence Interval [CI]: 1.07-1.26, p < 0.001). A linear dose-response relationship was observed in the restricted cubic spline (RCS) regression (p for overall < 0.001, p for nonlinear = 0.293). This association remained consistent in sensitivity analyses and subgroup analyses. The diagnostic utility of the UHR index for GDM was limited (Area Under the Curve [AUC] = 0.611, 95% CI: 0.554-0.667).
Conclusions: Although UHR demonstrated limited independent diagnostic accuracy (AUC = 0.611), its dual role in correlating inflammation and lipid metabolism may confer complementary value within multiparametric models, a hypothesis that warrants future research validation.
Keywords: NHANES database; UHR index; Uric acid; gestational diabetes mellitus; high-density lipoprotein cholesterol.