{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:19:53Z","timestamp":1777879193960,"version":"3.51.4"},"reference-count":36,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Endocrinology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Stress-induced hyperglycemia ratio (SHR) has shown strong correlations with diabetes risk. However, its relationship with gestational diabetes mellitus (GDM) remains an area of limited research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Based on the National Health and Nutrition Examination Survey (NHANES) database, this cross-sectional study aims to explore the association between SHR and GDM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The study included 461 pregnant women from NHANES between 1999 and 2016. Logistic regression analysis was performed to investigate the relation between SHR and GDM, as well as the weighted tertiles of SHR. Stratified and subgroup analyses assessed the association between SHR and GDM. Restricted cubic splines (RCS) delineated the nonlinear relationship between SHR and GDM. Moreover, a two-segment linear regression model was employed to test the threshold effect of SHR on GDM. Stratified analysis was conducted by stratifying by months of pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among the 461 eligible women included in the study, SHR was a critical risk factor for GDM. Higher SHR values were associated with an elevated likelihood of developing GDM after accounting for other variables (OR: 1.77, 95% CI: 1.37\u20132.28,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). This relationship was maintained across different SHR levels when analyzed in tertiles (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Further subgroup analyses based on education level and alcohol consumption status showed a consistent positive correlation between SHR and GDM risk in each group. A nonlinear relationship between SHR and GDM risk was confirmed by RCS. Threshold effect analysis further revealed a significant positive association between SHR and GDM when SHR was \u2264 15.75, whereas no significant association was observed beyond this threshold. The results of stratified analysis showed a significant positive correlation between SHR and GDM from 1 to 5\u2009months of pregnancy (OR\u2009=\u20092.16, 95% CI: 1.12\u20134.16,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.026). However, no significant SHR-GDM association was observed from 6 to 10\u2009months of pregnancy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>SHR is significantly positively correlated with an increased risk of GDM in early pregnancy. These results highlight the potential utility of SHR as a clinical marker for early identification and intervention in GDM risk cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20420188261431025","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T03:22:23Z","timestamp":1774322543000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Stress-induced hyperglycemia ratio and gestational diabetes mellitus: a cross-sectional study based on NHANES database"],"prefix":"10.1177","volume":"17","author":[{"given":"Yina","family":"Piao","sequence":"first","affiliation":[{"name":"Department of Obstetric, The First People\u2019s Hospital of Xiaoshan District, Hangzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6027-8954","authenticated-orcid":false,"given":"Mengxia","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Obstetric, The First People\u2019s Hospital of Xiaoshan District, 199 Shixin South Road, Xiaoshan District, Hangzhou 311200, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"e_1_3_4_2_2","volume-title":"StatPearls","author":"Quintanilla Rodriguez BS","year":"2025","unstructured":"Quintanilla Rodriguez BS, Vadakekut ES, Mahdy H. Gestational diabetes. StatPearls. Treasure Island (FL): StatPearls Publishing, 2025."},{"key":"e_1_3_4_3_2","volume-title":"Idf diabetes atlas","author":"Magliano DJ","year":"2021","unstructured":"Magliano DJ, Boyko EJ and committee IDFDAtes. IDF Diabetes Atlas. Idf diabetes atlas. Brussels: International Diabetes Federation, 2021."},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2021-067946"},{"key":"e_1_3_4_5_2","first-page":"3361","article-title":"Adverse effects of gestational diabetes-related risk factors on pregnancy outcomes and intervention measures","volume":"20","author":"Zhuang W","year":"2020","unstructured":"Zhuang W, Lv J, Liang Q, et al. Adverse effects of gestational diabetes-related risk factors on pregnancy outcomes and intervention measures. Exp Ther Med 2020; 20: 3361\u20133367.","journal-title":"Exp Ther Med"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-023-02233-x"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.4103\/ijmr.IJMR_852_18"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9113451"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2015-2660"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-024-02567-7"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2024.10.018"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/apt.15500"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-025-02610-1"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc09-1848"},{"key":"e_1_3_4_16_2","article-title":"Classification and diagnosis of diabetes: standards of medical care in diabetes-2020","volume":"43","author":"American Diabetes A. 2","year":"2020","unstructured":"American Diabetes A. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2020. Diabetes Care 2020; 43: S14\u2013S31.","journal-title":"Diabetes Care"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2022.05.031"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-78852-y"},{"key":"e_1_3_4_19_2","article-title":"Sleep duration time and human papillomavirus infection risk: the U-shaped relationship revealed by NHANES data","volume":"19","author":"Hu H","year":"2024","unstructured":"Hu H, Wu Y, Zhao M, et al. Sleep duration time and human papillomavirus infection risk: the U-shaped relationship revealed by NHANES data. PLoS One 2024; 19: e0301212.","journal-title":"PLoS One"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-021-02685-1"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1330206"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.6458"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-024-03376-0"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12967-022-03353-3"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1080\/10641963.2023.2233712"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-025-21292-8"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-024-04045-2"},{"key":"e_1_3_4_28_2","article-title":"The impact of educational attainment on gestational diabetes mellitus is mediated by body mass index: a Mendelian randomization study","volume":"104","author":"Zhu S","year":"2025","unstructured":"Zhu S, Gui R, Mu J, et al. The impact of educational attainment on gestational diabetes mellitus is mediated by body mass index: a Mendelian randomization study. Medicine (Baltimore) 2025; 104: e42008.","journal-title":"Medicine (Baltimore)"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.13023"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-019-4881-6"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/2590415"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-91258-8"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-013509"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1089\/met.2016.0124"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms19113342"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.852149"},{"key":"e_1_3_4_37_2","first-page":"199","article-title":"Update on prenatal care","volume":"89","author":"Zolotor AJ","year":"2014","unstructured":"Zolotor AJ, Carlough MC. Update on prenatal care. Am Fam Physician 2014; 89: 199\u2013208.","journal-title":"Am Fam Physician"}],"container-title":["Therapeutic Advances in Endocrinology and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20420188261431025","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20420188261431025","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20420188261431025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:37:15Z","timestamp":1777592235000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20420188261431025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":36,"alternative-id":["10.1177\/20420188261431025"],"URL":"https:\/\/doi.org\/10.1177\/20420188261431025","relation":{},"ISSN":["2042-0188","2042-0196"],"issn-type":[{"value":"2042-0188","type":"print"},{"value":"2042-0196","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"article-number":"20420188261431025"}}