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Abstract
Objective To develop and validate a set of risk scores for the prediction of gestational diabetes mellitus (GDM) before the 15th gestational week using an established population-based prospective cohort.
Methods From October 2010 to August 2012, 19 331 eligible pregnant women were registered in the three-tiered antenatal care network in Tianjin, China, to receive their antenatal care and a two-step GDM screening. The whole dataset was randomly divided into a training dataset (for development of the risk score) and a test dataset (for validation of performance of the risk score). Logistic regression was performed to obtain coefficients of selected predictors for GDM in the training dataset. Calibration was estimated using Hosmer-Lemeshow test, while discrimination was checked using area under the receiver operating characteristic curve (AUC) in the test dataset.
Results In the training dataset (total=12 887, GDM=979 or 7.6%), two risk scores were developed, one only including predictors collected at the first antenatal care visit for early prediction of GDM, like maternal age, body mass index, height, family history of diabetes, systolic blood pressure, and alanine aminotransferase; and the other also including predictors collected during pregnancy, that is, at the time of GDM screening, like physical activity, sitting time at home, passive smoking, and weight gain, for maximum performance. In the test dataset (total=6444, GDM=506 or 7.9%), the calibrations of both risk scores were acceptable (both p for Hosmer-Lemeshow test >0.25). The AUCs of the first and second risk scores were 0.710 (95% CI: 0.680 to 0.741) and 0.712 (95% CI: 0.682 to 0.743), respectively (p for difference: 0.9273).
Conclusion Both developed risk scores had adequate performance for the prediction of GDM in Chinese pregnant women in Tianjin, China. Further validations are needed to evaluate their performance in other populations and using different methods to identify GDM cases.
- gestational diabetes mellitus
- risk factor modeling
- behavioral interventions
- epidemiology
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Footnotes
SG, JL and XY contributed equally.
Contributors XY, HL, GH, JCNC and ZY conceived and designed the study; all authors, except GH, ZY, and JCNC contributed to the collection of the data. SG and JL analyzed the data and wrote the first draft; XY revised the draft critically for important intellectual content. All authors gave critical comments and contributed to the writing of the manuscript; SG, JL, XY and HZ take full responsibility for the work as a whole, including the study design, access to data, and the decision to submit and publish the manuscript.
Funding This work was supported by National Key Research and Development Program of China (Grant nos: 2018YFC1313900 and 2018YFC1313903), and National Natural Science Foundation of China (Grant nos: 81870549, 81602922, and 81900724).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study ethics was approved by the Ethics Committee for Clinical Research of TWCHC. Written informed consent was obtained from all pregnant women before data collection.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement The raw data were generated at TWCHC. Data supporting the findings of this study are available from the corresponding author on reasonable request.