Abstract
BACKGROUND: Elevated uric acid (UA) has become a global health concern. We aimed to investigate the impact of UA in women during early pregnancy on the subsequent risk of gestational diabetes mellitus (GDM). METHODS: Pregnant women in their first trimester were recruited from a birth cohort study conducted in Xi'an, China, between July 2018 and December 2023. A generalized linear model (GLM) was used to calculate risk ratios (RRs) and 95% confidence intervals (CIs) for the effects of UA levels. RESULTS: Compared with the first quartile of UA, the second (RR = 1.15, 95% CI = 1.04-1.28), third (RR = 1.27, 95% CI = 1.15-1.41), and fourth (RR = 1.46, 95% CI = 1.32-1.61) quartiles were associated with an increased risk of GDM. Moreover, UA was the strongest predictor among all variables in the random forest model except for BMI. Importantly, higher UA levels were associated with an increased risk of GDM (OR = 1.39, 95% CI = 1.29-1.50) as long as BMI exceeded 18.5 kg/m². The highest GDM risk was observed in high UA/high BMI combinations. CONCLUSIONS: This study demonstrated that higher UA levels during early pregnancy were associated with an increased risk of GDM. These findings suggest a link that warrants further investigation to determine if UA plays a causal role or is a marker of underlying pathology.