Risk Prediction Model of Gestational Diabetes Mellitus in a Chinese Population Based on a Risk Scoring System

Abstract

Introduction: Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes. Accurate models for early prediction of GDM are lacking. This study aimed to explore an early risk prediction model to identify women at high risk of GDM through a risk scoring system.

Methods: This was a retrospective cohort study of 785 control pregnancies and 855 women with GDM. Maternal clinical characteristics and biochemical measures were extracted from the medical records. Logistic regression analysis was used to obtain coefficients of selected predictors for GDM in the training cohort. The discrimination and calibration of the risk scores were evaluated by the receiver-operating characteristic (ROC) curve and a Hosmer-Lemeshow test in the internal and external validation cohort, respectively.

Results: In the training cohort (total = 1640), two risk scores were developed, one including predictors collected at the first antenatal care visit for early prediction of GDM, such as age, height, pre-pregnancy body mass index, educational background, family history of diabetes, menstrual history, history of cesarean delivery, GDM, polycystic ovary syndrome, hypertension, and fasting blood glucose (FBG), and the total risk score also including FBG and triglyceride values during 14-20 gestational weeks. Our total risk score yielded an area under the curve (AUC) of 0.845 (95% CI = 0.805-0.884). This performed better in an external validation cohort, with an AUC of 0.886 (95% CI = 0.856-0.916).

Conclusion: The GDM risk score, which incorporates several potential clinical features with routine biochemical measures of GDM, appears to be a sensitive and reliable screening tool for earlier detection of GDM risk.

Keywords: Early pregnancy; Gestational diabetes; Prediction model; Risk score.

Fig. 1

Area under the receiver-operating characteristic curve (AUC) of the first risk score and the total risk score in the validation cohorts. a In the internal validation cohort, AUCs of the first risk scores and the total risk score predicting GDM were 0.774 (95% CI = 0.733–0.814) and 0.845 (95% CI = 0.805–0.884), respectively. b In the external validation cohort, AUCs of the risk scores were 0.822 (95% CI = 0.785–0.858) and 0.886 (95% CI = 0.856–0.916), respectively

Fig. 2

Calibration curve for observed versus predicted risk of developing GDM in the internal cohort (a, b) and the external cohort (c, d)