First-trimester inflammation and dyslipidemia in preterm delivery: the role of monocyte-to-HDL cholesterol ratio and lipid profiles.

Background: Preterm delivery (PTD) remains a leading cause of neonatal morbidity and mortality. Maternal inflammatory disturbances during early pregnancy may contribute to PTD pathogenesis. Alterations in lipid metabolism, particularly decreased high-density lipoprotein cholesterol (HDLc) and the HDLc-to-low-density lipoprotein cholesterol (HDLc/LDLc) ratio, alongside inflammatory markers such as the monocyte-to-HDLc ratio (MHR), have been associated with adverse pregnancy outcomes. However, their predictive role for PTD requires further investigation.

Aim: This study aimed to evaluate the relationship between first-trimester maternal lipid profiles, HDLc, HDLc/LDLc ratio, and MHR, and the subsequent risk of PTD.

Methods: A retrospective analysis was conducted on 152 pregnant women, including 53 PTD cases and 99 term deliveries. First-trimester complete blood counts and lipid profiles were assessed. MHR was calculated as the monocyte count divided by the HDLc level. Regression and correlation analyses evaluated associations, while receiver operating characteristic (ROC) curve analysis assessed MHR's predictive value for PTD.

Results: PTD cases exhibited significantly lower HDLc levels and HDLc/LDLc ratios and higher MHR values (p < 0.05). HDLc showed a negative correlation with PTD risk (r =  - 0.308, p = 0.000), while MHR correlated positively (r = 0.250, p = 0.002). ROC analysis identified an MHR cut-off of 0.0078 for PTD prediction (AUC = 0.652, 95% CI 0.562-0.741, p = 0.002).

Conclusion: First-trimester elevated MHR and reduced HDLc levels may serve as early biomarkers for PTD risk, reflecting underlying inflammatory and metabolic dysregulation. Early assessment of MHR could enhance risk stratification and guide preventive strategies. Further studies are warranted to validate these findings.