BACKGROUND & OBJECTIVE: To analyze whether there is an association between pre-pregnancy lipid parameters and gestational diabetes mellitus (GDM) in women undergoing assisted reproductive technologies (ART), a group especially at risk for GDM, and if so, which parameter is associated the strongest. METHODS: Data was collected at the Reproductive and Genetic Hospital CITIC-Xiangya in Changsha, China from January 2017 to December 2018. The measured lipid parameters include LDL (low-density lipoprotein), HDL (high-density lipoprotein), TC (total cholesterol), and TG (triglycerides). RESULTS: 119 (15.5%) of the 767 patients developed GDM. On average, women who developed GDM were older, had a higher BMI, LDL, TC, and TG, and lower HDL. After adjusting for confounders, LDL and HDL showed a significant association with GDM (p < 0.05), but TC and TG did not. Binary LDL/HDL and TC/HDL ratios showed the strongest association with GDM incidence (OR 1.957 [95%CI 1.258-3.044] and 1.942 [1.243-3.034] respectively). Subgroup analysis showed that an elevated LDL/HDL ratio also increased GDM risk in subgroups with a typically lower prevalence of GDM, such as young women with a low BMI and low blood pressure. Both lipid ratios (LDL/HDL and TC/HD) show strong interactions with baseline age, fasting plasma glucose, and LH. CONCLUSIONS: In this cohort of Chinese women undergoing ART, pre-pregnancy LDL/HDL and TC/HDL were associated with GDM the strongest from the lipid parameters and could be useful to estimate GDM risk even before ART treatments and pregnancy. CLINICAL TRIAL NUMBER: NCT03503006 registered on the 21st of March 2018 (on clinicaltrials.gov). https://clinicaltrials.gov/study/NCT03503006?locStr=Changsha,%20Hunan,%20China&country=China&state=Hunan&city=Changsha&cond=ivf&rank=2 .

2nd Faculty of Medicine Charles University Prague 150 06 Czech Republic

5th Department of Medicine University Medical Centre Mannheim University of Heidelberg 68167 Mannheim Germany

Center for Development and Regeneration Guangzhou Institutes of Biomedicine and Health Chinese Academy of Sciences Guangzhou 510530 China

Centre for Preventive Medicine and Digital Health Baden Württemberg Medical Faculty Mannheim University of Heidelberg 68167 Mannheim Germany

European Centre for Angioscience ECAS Medical Faculty Mannheim University of Heidelberg 68167 Mannheim Germany

Institute of Medical Diagnostics IMD 12247 Berlin Germany

Institute of Reproductive and Stem Cell Engineering School of Basic Medical Science Central South University Changsha 410017 China

Key Laboratory of Stem Cells and Reproductive Engineering Ministry of Health Changsha 410017 China

Medical Faculty of Charité Universitätsmedizin Berlin 10117 Berlin Germany

Reproductive and Genetic Hospital of CITIC Xiangya Changsha 410008 China

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NCT03503006