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已发表论文
全身免疫炎症指数升高与妊娠期糖尿病相关：一项多中心回顾性研究
Authors Li J, Li Q , Zhang Y , Chen X, Zhang C, Chen Y, Gu Y, Yue C
Received 19 June 2025
Accepted for publication 27 January 2026
Published 5 February 2026 Volume 2026:19 548249
DOI https://doi.org/10.2147/JIR.S548249
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Dr Quan Zhang
Jingyang Li,1,* Qiong Li,2,* Yixuan Zhang,1 Xiaohu Chen,3 Chunyi Zhang,3 Yu Chen,1 Ying Gu,1 Chaoyan Yue3
1Department of Obstetrics, Wuxi Maternity and Child Health Hospital, Jiangnan University, Wuxi, People’s Republic of China; 2Department of Obstetrics and Gynecology, The First People’s Hospital of Chenzhou, Chenzhou, People’s Republic of China; 3Obstetrics & Gynecology Hospital of Fudan University, Shanghai Key Lab of Reproduction and Development, Shanghai Key Lab of Female Reproductive Endocrine Related Diseases, Shanghai, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Chaoyan Yue, Obstetrics & Gynecology Hospital of Fudan University, Shanghai Key Laboratory of Reproduction and Development, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fang Xie Road, No. 419, Shanghai, People’s Republic of China, Email 20111250007@fudan.edu.cn Ying Gu, Department of Obstetrics, Wuxi Maternity and Child Health Hospital, Jiangnan University, No. 48, Huai Shu Lane, Wuxi, 214000, People’s Republic of China, Email guyingwxfy@163.com
Background: The systemic immune-inflammation index (SII), an integrative biomarker reflecting inflammatory and immune status, has been implicated in metabolic disorders. However, its association with gestational diabetes mellitus (GDM) remains unclear. This study aimed to investigate whether elevated SII is associated with an increased risk of GDM.
Objective: We aimed to clarify whether systemic SII is related to the occurrence of GDM and the relationship between changes in SII and adverse pregnancy outcomes associated with GDM.
Methods: This study analyzed 47,480 singleton pregnancies between 2018 and 2024, including 6599 GDM cases and 40,881 controls. SII was calculated before 24 weeks of gestation, and participants were categorized by SII quartiles. Multivariable logistic regression was used to assess associations between SII and GDM (primary outcome), insulin-requiring GDM (A2), preeclampsia, and large-for-gestational-age infants. In addition, interaction tests and smooth curve fitting methods were adopted to explore the relationship between SII and gestational diabetes mellitus (GDM) and related adverse pregnancy outcomes.
Results: After adjustment, higher SII quartiles showed a dose-dependent increase in GDM risk: Q2 (aOR = 1.19, 95% CI: 1.08– 1.30), Q3 (aOR = 1.26, 1.15– 1.38), Q4 (aOR = 1.56, 1.43– 1.71; P < 0.0001). Stronger associations were observed for GDM A2 and GDM with preeclampsia. The association with LGA was weaker and only significant in Q3. Subgroup analyses revealed consistent associations across age and BMI, though the effect was marginally stronger in multiparous women (interaction P=0.0213< 0.05). No significant interactions were found for BMI or age.
Conclusion: Elevated SII in early pregnancy is independently associated with an increased risk of GDM, supporting its potential utility as an early predictive marker for GDM screening.
Keywords: systemic immune-inflammation index, gestational diabetes mellitus, insulin resistance, retrospective studies
1Department of Obstetrics, Wuxi Maternity and Child Health Hospital, Jiangnan University, Wuxi, People’s Republic of China; 2Department of Obstetrics and Gynecology, The First People’s Hospital of Chenzhou, Chenzhou, People’s Republic of China; 3Obstetrics & Gynecology Hospital of Fudan University, Shanghai Key Lab of Reproduction and Development, Shanghai Key Lab of Female Reproductive Endocrine Related Diseases, Shanghai, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Chaoyan Yue, Obstetrics & Gynecology Hospital of Fudan University, Shanghai Key Laboratory of Reproduction and Development, Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Fang Xie Road, No. 419, Shanghai, People’s Republic of China, Email 20111250007@fudan.edu.cn Ying Gu, Department of Obstetrics, Wuxi Maternity and Child Health Hospital, Jiangnan University, No. 48, Huai Shu Lane, Wuxi, 214000, People’s Republic of China, Email guyingwxfy@163.com
Background: The systemic immune-inflammation index (SII), an integrative biomarker reflecting inflammatory and immune status, has been implicated in metabolic disorders. However, its association with gestational diabetes mellitus (GDM) remains unclear. This study aimed to investigate whether elevated SII is associated with an increased risk of GDM.
Objective: We aimed to clarify whether systemic SII is related to the occurrence of GDM and the relationship between changes in SII and adverse pregnancy outcomes associated with GDM.
Methods: This study analyzed 47,480 singleton pregnancies between 2018 and 2024, including 6599 GDM cases and 40,881 controls. SII was calculated before 24 weeks of gestation, and participants were categorized by SII quartiles. Multivariable logistic regression was used to assess associations between SII and GDM (primary outcome), insulin-requiring GDM (A2), preeclampsia, and large-for-gestational-age infants. In addition, interaction tests and smooth curve fitting methods were adopted to explore the relationship between SII and gestational diabetes mellitus (GDM) and related adverse pregnancy outcomes.
Results: After adjustment, higher SII quartiles showed a dose-dependent increase in GDM risk: Q2 (aOR = 1.19, 95% CI: 1.08– 1.30), Q3 (aOR = 1.26, 1.15– 1.38), Q4 (aOR = 1.56, 1.43– 1.71; P < 0.0001). Stronger associations were observed for GDM A2 and GDM with preeclampsia. The association with LGA was weaker and only significant in Q3. Subgroup analyses revealed consistent associations across age and BMI, though the effect was marginally stronger in multiparous women (interaction P=0.0213< 0.05). No significant interactions were found for BMI or age.
Conclusion: Elevated SII in early pregnancy is independently associated with an increased risk of GDM, supporting its potential utility as an early predictive marker for GDM screening.
Keywords: systemic immune-inflammation index, gestational diabetes mellitus, insulin resistance, retrospective studies