Development and validation of a clinical model for preconception and early pregnancy risk prediction of gestational diabetes mellitus in nulliparous women

Abstract

Implementation of dietary and lifestyle interventions prior to and early in pregnancy in high risk women has been shown to reduce the risk of gestational diabetes mellitus (GDM) development later in pregnancy. Although numerous risk factors for GDM have been identified, the ability to accurately identify women before or early in pregnancy who could benefit most from these interventions remains limited. As nulliparous women are an under-screened population with risk profiles that differ from their multiparous counterparts, development of a prediction model tailored to nulliparous women may facilitate timely preventive intervention and improve maternal and infant outcomes. We aimed to develop and validate a model for preconception and early pregnancy prediction of gestational diabetes mellitus based on clinical risk factors for nulliparous women. A risk prediction model was built within a large California birth cohort including singleton live birth records from 2007–2012. Model accuracy was assessed both internally and externally, within a cohort of women who delivered at University of Iowa Hospitals and Clinics between 2009–2017, using discrimination and calibration. Differences in predictive accuracy of the model were assessed within specific racial/ethnic groups. The prediction model included five risk factors: race/ethnicity, age at delivery, pre-pregnancy body mass index, family history of diabetes, and pre-existing hypertension. The area under the curve (AUC) for the California internal validation cohort was 0.732 (95% confidence interval (CI) 0.728, 0.735), and 0.710 (95% CI 0.672, 0.749) for the Iowa external validation cohort. The model performed particularly well in Hispanic (AUC 0.739) and Black women (AUC 0.719). Our findings suggest that estimation of a woman’s risk for GDM through model-based incorporation of risk factors accurately identifies those at high risk (i.e., predicted risk >6%) who could benefit from preventive intervention encouraging prompt incorporation of this tool into preconception and prenatal care.

Adipokines in early and mid-pregnancy and subsequent risk of gestational diabetes: a longitudinal study in a multiracial cohort

“…A final risk prediction model was developed by sequentially adding adipokines until the AUC stabilized. 30 Prediction analyses were implemented in R V.3.5.1. All other analyses were implemented using SAS V.9.4 (SAS Institute, Cary, North Carolina, USA), with α<0.05 as the level of significance.…”

Prevention of Gestational Diabetes: The Role of Dietary Intake, Physical Activity, and Weight before, during, and between Pregnancies

“…76,77 A preconception risk assessment by health care professionals may identify women with preexisting diabetes, and also identify women at risk of GDM. 78 Risk assessment tools have shown nulliparous women at risk of GDM may be accurately identified before pregnancy based on a set of easily obtainable lifestyle and health-related characteristics 79,80 ; however, further research is needed to determine if preconception risk identification is acceptable and if model implementation followed by targeted preconception care reduces rates of GDM. Moreover, risk assessment among women intending to become pregnant only reaches a proportion of all women who become pregnant with approximately half of all pregnancies being unplanned.…”

Application of ATR-FTIR Spectroscopy and Decreased Proteins As Parameter of Negative Neonatal Outcomes in Women With Gestational Diabetes Mellitus

“…Newborns of women with Gestational Diabetes Mellitus (GDM) are more likely to have complications at birth. Among the most common complications that occur in these in newborns are macrosomia, shoulder dystocia at birth 1 , congenital heart defects 2 , congenital malformations 3 , hyperbilirubinemia, respiratory distress 4,5 and stillbirth 6 .…”