Circulating hyaluronidase in early pregnancy and increased risk of gestational diabetes in Chinese pregnant women: A nested case control study

•High HYAL1 in early pregnancy was associated with elevated risk of GDM.•There was a significant interaction between HYAL1 and ceramide 18:0 for GDM risk.•There was a significant interaction between HYAL1 and ceramide 18:1 for GDM risk.•There was a significant interaction between HYAL1 and ceramide 24:0 for GDM risk. To explore association of serum hyaluronidase 1 (HYAL1) level in early pregnancy with gestational diabetes mellitus (GDM), and to examine interactive effects of HYAL1 with ceramides species on GDM risk. We conducted a 1:1 matched case-control study (n = 414) of pregnant women from 2010 to 2012 in Tianjin, China. Blood samples were collected at the first antenatal care visit (at a median of 10th gestational weeks). Binary conditional logistic regression and restricted cubic spline (RCS) analysis were used to examine full-range risk association between HYAL1 and GDM. Additive interactions and multiplicative interactions were employed to test interactive effects of HYAL1 with ceramides species on GDM risk. Ln HYAL1 was linearly associated with GDM risk and the adjusted OR of HYAL1 ≥ vs.