Associação entre o índice de triglicérides-glicose (TyG) como marcador substituto de resistência à insulina e risco de diabetes mellitus gestacional (DMG): revisão sistemática atualizada e metanálise

Resumo original em inglês

O que aconteceu

This systematic review and meta-analysis evaluated whether the first-trimester triglyceride-glucose (TyG) index predicts subsequent gestational diabetes mellitus (GDM). MEDLINE/PubMed, Scopus, Embase, Web of Science, ScienceDirect, and the Cochrane Library were searched from inception to August 12, 2025. Eligible studies were prospective or retrospective cohorts including adult women with singleton pregnancies, first-trimester TyG assessment, and later GDM ascertainment; non-original studies, case reports/series, and duplicates were excluded. Risk of bias was assessed using ROBINS-E. Adjusted odds ratios (ORs) were pooled using random-effects models with REML and Hartung-Knapp adjustment. Sensitivity, subgroup, diagnostic accuracy, publication-bias, and GRADE certainty analyses were performed. Fourteen observational cohorts comprising 462,233 pregnant women were included; 30,875 (7%) developed GDM. Twelve studies contributed adjusted association estimates. Elevated first-trimester TyG was associated with higher odds of GDM (OR 2.35, 95% CI 1.88-2.94; I2=92%). The association persisted after excluding influential studies (OR 2.36, 95% CI 1.91-2.90; I2=30.6%) and was consistent in Asian populations and low-risk-of-bias studies. Diagnostic performance was moderate, with pooled sensitivity of 0.62 (95% CI 0.54-0.69), specificity of 0.64 (95% CI 0.60-0.69), and AUC of 0.67. Limitations included substantial heterogeneity, variable TyG thresholds, observational designs, and limited non-Asian evidence. First-trimester TyG is associated with increased GDM risk and may support early risk stratification, but its moderate diagnostic performance precludes use as a standalone screening test.PROSPERO registry: # CRD420251125511.

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