External Validation of the PeRSonal Gestational Diabetes Model for Predicting Adverse Pregnancy Outcomes in Women with Gestational Diabetes: A Retrospective Cohort Study in a Tertiary Hospital in Thailand
Abstract
Objective: This study aimed to validate the PeRSonal Gestational Diabetes (GDM) model with two-step glucose tolerance diagnostic criteria.
Material and Methods: A retrospective cohort study was conducted on participants having delivered with GDM diagnosis in a tertiary hospital; from October 1, 2020, until September 30, 2022. The main outcome was a composite of maternal and perinatal adverse pregnancy complications. Model validation evaluated the predictors and calculated risk by using a two-step glucose tolerance test in the PeRSonal model formula. Model performance was analyzed for discrimination, calibration, and overall performance.
Results: This study analyzed 685 from the initial 764 participants with GDM, with 218 (31.8%) developing adverse pregnancy outcomes. The most frequent adverse outcomes were hypertensive disorders in pregnancy 132 (19.3%) and neonatal hypoglycemia 91 (13.3%). This validation achieved an area under the curve (AUC) of 0.70 (95% confidence interval (CI) 0.65 to 0.74), calibration-in-the-large of 0.17, a calibration slope of 1.34, and a Brier score of 0.20, respectively. The cut-off clinical risk probability of 27.5% can predict adverse outcomes with a sensitivity of 67.3%, specificity of 63.8%, a positive predictive value (PPV) of 46.7%, and a negative predictive value (NPV) of 80.5%.
Conclusion: The PeRSonal model maintains its predictive effectiveness in two-step glucose tolerance diagnostic criteria.
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Wang H, Li N, Chivese T, Werfalli M, Sun H, Yuen L, et al. IDF diabetes atlas: estimation of global and regional gestational diabetes mellitus prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group’s Criteria. Diabetes Res Clin Pract 2022;183:109050.
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas. Diabetes Res Clin Pract 2019;157:107843.
Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract 2017;128:40-50.
ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care 2023;46(Suppl 1):S19-40.
Moon JH, Jang HC. Gestational diabetes mellitus: diagnostic approaches and maternal-offspring complications. Diabetes Metab J 2022;46:3-14.
Bidhendi Yarandi R, Vaismoradi M, Panahi MH, Gåre Kymre I, Behboudi-Gandevani S. Mild gestational diabetes, and adverse pregnancy outcome: a systemic review and meta-analysis. Front Med (Lausanne) 2021;8:699412.
Catalano PM, McIntyre HD, Cruickshank JK, McCance DR, Dyer AR, Metzger BE, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care 2012;35:780-6.
Scifres C, Feghali M, Althouse AD, Caritis S, Catov J. Adverse outcomes and potential targets for intervention in gestational diabetes and obesity. Obstet Gynecol 2015;126:316-25.
Murray SR, Reynolds RM. Short- and long-term outcomes of gestational diabetes and its treatment on fetal development. Prenat Diagn 2020;40:1085-91.
Cooray SD, Wijeyaratne LA, Soldatos G, Allotey J, Boyle JA, Teede HJ. The unrealized potential for predicting pregnancy complications in women with gestational diabetes: a systematic review and critical appraisal. Int J Environ Res Public Health 2020;17:3048.
Lappharat S, Liabsuetrakul T. Accuracy of screening tests for gestational diabetes mellitus in Southeast Asia: a systematic review of diagnostic test accuracy studies. Medicine (Baltimore) 2020;99:e23161. doi: 10.1097/MD.0000000000023161.
Guo XY, Shu J, Fu XH, Chen XP, Zhang L, Ji MX, et al. Improving the effectiveness of lifestyle interventions for gestational diabetes prevention: a meta-analysis and metaregression. BJOG 2019;126:311-20.
Wang Y, Ge Z, Chen L, Hu J, Zhou W, Shen S, et al. Risk prediction model of gestational diabetes mellitus in a Chinese population based on a risk scoring system. Diabetes Ther 2021;12:1721-34.
Sweeting AN, Wong J, Appelblom H, Ross GP, Kouru H, Williams PF, et al. A novel early pregnancy risk prediction model for gestational diabetes mellitus. Fetal Diagn Ther 2019;45:76- 84.
Hughes RC, Moore MP, Gullam JE, Mohamed K, Rowan J. An early pregnancy HbA1c ≥5.9% (41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes. Diabetes Care 2014;37:2953-9.
Wei Y, He A, Tang C, Liu H, Li L, Yang X, et al. Risk prediction models of gestational diabetes mellitus before 16 gestational weeks. BMC Pregnancy Childbirth 2022;22:889.
Lappharat S, Rothmanee P, Jandee K, Suksai M, Liabsuetrakul T. A model for predicting gestational diabetes mellitus in early pregnancy: a prospective study in Thailand. Obstet Gynecol Sci 2022;65:156-65.
Hinkle SN, Tsai MY, Rawal S, Albert PS, Zhang C. HbA1c measured in the first trimester of pregnancy and the association with gestational diabetes. Sci Rep 2018;8:12249.
Cooray SD, Boyle JA, Soldatos G, Allotey J, Wang H, Fernandez-Felix BM, et al. Development, validation and clinical utility of a risk prediction model for adverse pregnancy outcomes in women with gestational diabetes: The PeRSonal GDM model. Clin Med 2022;52:101637.
Collins GS, Ogundimu EO, Altman DG. Sample size considerations for the external validation of a multivariable prognostic model: a resampling study. Stat Med 2016;35:214- 26.
Kim M, Park J, Kim SH, Kim YM, Yee C, Choi SJ, et al. The trends and risk factors to predict adverse outcomes in gestational diabetes mellitus: a 10-year experience from 2006 to 2015 in a single tertiary center. Obstet Gynecol Sci 2018;61:309-18.
Tenenbaum-Gavish K, Sharabi-Nov A, Binyamin D, Møller HJ, Danon D, Rothman L, et al. First trimester biomarkers for prediction of gestational diabetes mellitus. Placenta 2020;101: 80-9.
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