Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Oct 15, 2023; 14(10): 1541-1550
Published online Oct 15, 2023. doi: 10.4239/wjd.v14.i10.1541
Establishment and evaluation of a risk prediction model for gestational diabetes mellitus
Qing Lin, Zhuan-Ji Fang
Qing Lin, Zhuan-Ji Fang, Department of Obstetrics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350001, Fujian Province, China
Author contributions: Lin Q designed and performed the research and wrote the paper; Fang ZJ designed the research and supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Fujian Maternity and Child Health Hospital.
Informed consent statement: As the study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhuan-Ji Fang, MM, Associate Chief Physician, Department of Obstetrics, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, No. 18 Daoshan Rd., Gulou Dist, Fuzhou 350001, Fujian Province, China. fzlqtg@163.com
Received: August 1, 2023
Peer-review started: August 1, 2023
First decision: August 16, 2023
Revised: August 21, 2023
Accepted: September 14, 2023
Article in press: September 14, 2023
Published online: October 15, 2023
Processing time: 69 Days and 10.6 Hours
Abstract
BACKGROUND

Gestational diabetes mellitus (GDM) is a condition characterized by high blood sugar levels during pregnancy. The prevalence of GDM is on the rise globally, and this trend is particularly evident in China, which has emerged as a significant issue impacting the well-being of expectant mothers and their fetuses. Identifying and addressing GDM in a timely manner is crucial for maintaining the health of both expectant mothers and their developing fetuses. Therefore, this study aims to establish a risk prediction model for GDM and explore the effects of serum ferritin, blood glucose, and body mass index (BMI) on the occurrence of GDM.

AIM

To develop a risk prediction model to analyze factors leading to GDM, and evaluate its efficiency for early prevention.

METHODS

The clinical data of 406 pregnant women who underwent routine prenatal examination in Fujian Maternity and Child Health Hospital from April 2020 to December 2022 were retrospectively analyzed. According to whether GDM occurred, they were divided into two groups to analyze the related factors affecting GDM. Then, according to the weight of the relevant risk factors, the training set and the verification set were divided at a ratio of 7:3. Subsequently, a risk prediction model was established using logistic regression and random forest models, and the model was evaluated and verified.

RESULTS

Pre-pregnancy BMI, previous history of GDM or macrosomia, hypertension, hemoglobin (Hb) level, triglyceride level, family history of diabetes, serum ferritin, and fasting blood glucose levels during early pregnancy were de-termined. These factors were found to have a significant impact on the development of GDM (P < 0.05). According to the nomogram model’s prediction of GDM in pregnancy, the area under the curve (AUC) was determined to be 0.883 [95% confidence interval (CI): 0.846-0.921], and the sensitivity and specificity were 74.1% and 87.6%, respectively. The top five variables in the random forest model for predicting the occurrence of GDM were serum ferritin, fasting blood glucose in early pregnancy, pre-pregnancy BMI, Hb level and triglyceride level. The random forest model achieved an AUC of 0.950 (95%CI: 0.927-0.973), the sensitivity was 84.8%, and the specificity was 91.4%. The Delong test showed that the AUC value of the random forest model was higher than that of the decision tree model (P < 0.05).

CONCLUSION

The random forest model is superior to the nomogram model in predicting the risk of GDM. This method is helpful for early diagnosis and appropriate intervention of GDM.

Keywords: Gestational diabetes mellitus; Prediction model; Model evaluation; Random forest model; Nomograms; Risk factor

Core Tip: Gestational diabetes mellitus (GDM) is a common pregnancy complication, which has an important impact on maternal and child health. Early prediction of GDM can result in timely interventions in patients and improve pregnancy outcomes. This study examined various risk factors associated with GDM and established and compared two prediction models: The nomogram model and the random forest model. The random forest model has good predictive ability, which can effectively predict the risk of GDM and provide accurate references for early prevention and management of GDM.