Introduction: There is evidence linking high triglyceride (TG) levels with increased fetal birth weight, macrosomia, and cardiovascular disorders. TG values below 150 mg/dL are considered normal. However, there are no established reference curves for TG levels during pregnancy.

Objectives: To evaluate the association between TG levels and hypertensive disorders (gestational hypertension, preeclampsia), large for gestational age (LGA), macrosomia, and postpartum reclassification (PPR) outcomes in patients with gestational diabetes.

Materials and Methods: A total of 563 patients with gestational diabetes (2017–2021) who had TG levels measured in the third trimester were included. TG levels were categorized using <150 mg/dL as the normal threshold, and associations with gestational hypertension (GH), preeclampsia (PE), LGA, and macrosomia were assessed. ROC curves were used to determine the area under the curve (AUC) for each outcome. Finally, the relationship between TG levels and postpartum reclassification (PPR) was analyzed. Macrosomia was defined as a birth weight ≥4000 g, and LGA as ≥90th percentile (P90).

Results: Of the 563 patients, 44 (7.8%) had normal TG levels (<150 mg/dL) and 519 (92.2%) had elevated TG levels (≥150 mg/dL). After excluding 3, 516 were analyzed. Macrosomia occurred in 75 cases (14.5%), LGA in 62 (11.9%), and GH/PE in 55 (10.7%). PPR was not performed in 340 patients (65.5%). Among 179 evaluated, 73 (40.7%) were positive: 64 (87.6%) had impaired glucose tolerance, and 9 (12.3%) had type 2 diabetes. No significant differences were found between TG groups. Mean TG in positive PPR was 256 mg/dL vs. 254 mg/dL in negative.

Conclusion: Using 150 mg/dL as a cutoff, no significant differences were found. AUC values were near 0.5, indicating low clinical utility. TG levels could not define a diagnostic cutoff for hypertension, LGA, macrosomia, or PPR.

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