Abstract
BACKGROUND: The Atherogenic Index of Plasma (AIP) is a novel lipid parameter calculated as the logarithmic ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) levels. Initially proposed as a marker for predicting cardiovascular disease risk and atherosclerosis, AIP has more recently been found to be closely associated with insulin resistance, metabolic syndrome, and the development of type 2 diabetes(T2DM). However, its role in women with a history of GDM, a unique high-risk population, remains unclear. This study aims to investigate the relationship between the AIP and type 2 diabetes (T2DM) prevalence in women with a history of GDM. METHODS: A cross-sectional analysis was conducted using data from 4,690 parous women from the 2007-2018 National Health and Nutrition Examination Survey (NHANES), with participants stratified by GDM history. Multivariate logistic regression models were applied to evaluate the association between the AIP and T2DM among women with a history of GDM. Subgroup analyses and interaction tests were performed within the GDM group to explore effect modification. Restricted cubic spline (RCS) models were used to assess the linearity of the association between the AIP and T2DM prevalence. Mediation analysis was also conducted to examine whether the AIP score mediated the relationship between GDM history and T2DM. RESULTS: Among women with a history of GDM, higher AIP values were significantly associated with increased T2DM prevalence. A dose-response relationship was observed across AIP quartiles, with women in the highest quartile showing a markedly elevated risk (adjusted OR = 5.01, 95% CI: 1.89, 13.25, p < 0.01). RCS analysis revealed a linear association between AIP and T2DM in this population. Mediation analysis further revealed that the AIP partially mediated the association between GDM and T2DM, accounting for 8.0% of the total effect (95% CI: 5.1-12.5%). CONCLUSION: AIP is associated with T2DM prevalence in women with a history of GDM. These findings indicate that the AIP may serve as a potential early indicator for identifying individuals at elevated risk of progressing from GDM to T2DM.