Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Reproductive Endocrinology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China.
Center for Reproductive Medicine, Peking University Third Hospital, Haidian District, Beijing 100191, China.
J Clin Endocrinol Metab. 2023 Jul 14;108(8):1998-2006. doi: 10.1210/clinem/dgad052.
Gestational diabetes mellitus (GDM) is a common obstetric complication. Although early intervention could prevent the development of GDM, there was no consensus on early identification for women at high risk of GDM.
To develop a reliable prediction model of GDM in early pregnancy.
In this prospective cohort study, between May 30, 2021, and August 13, 2022, a total of 721 women were included from Women's Hospital, Zhejiang University School of Medicine. Participants were asked to complete an oral glucose tolerance test (OGTT) during gestational weeks 7 through 14 for early prediction of GDM, and at weeks 24 through 28 for GDM diagnosis. Using OGTT results and baseline characteristics, logistic regression analysis was used to construct the prediction model. Receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, decision clinical analysis, and a nomogram were used for model performances assessment and visualization. Internal and external validation was performed to testify the stability of this model.
According to the International Association of Diabetes and Pregnancy Study Groups criteria in early OGTT, the mean (SD) age was 30.5 ± 3.7 years in low-risk participants and 31.0 ± 3.9 years in high-risk participants. The area under ROC curve (AUC) of the existing criteria at weeks 7 through 14 varied from 0.705 to 0.724. Based on maternal age, prepregnancy body mass index, and results of early OGTT, the AUC of our prediction model was 0.8720, which was validated by both internal (AUC 0.8541) and external (AUC 0.8241) confirmation.
The existing diagnostic criteria were unsatisfactory for early prediction of GDM. By combining early OGTT, we provided an effective prediction model of GDM in the first trimester.
妊娠期糖尿病（GDM）是一种常见的产科并发症。虽然早期干预可以预防 GDM 的发生，但对于 GDM 高危妇女的早期识别尚无共识。
建立一种早期妊娠 GDM 的可靠预测模型。
本前瞻性队列研究于 2021 年 5 月 30 日至 2022 年 8 月 13 日期间，纳入浙江大学医学院附属妇产科医院的 721 名女性。参与者在妊娠 7-14 周时进行口服葡萄糖耐量试验（OGTT）以早期预测 GDM，在 24-28 周时进行 OGTT 以诊断 GDM。使用 OGTT 结果和基线特征，通过逻辑回归分析构建预测模型。通过接收者操作特征（ROC）曲线、Hosmer-Lemeshow 检验、决策曲线分析和列线图评估和可视化模型性能。通过内部和外部验证来检验该模型的稳定性。
根据早期 OGTT 的国际妊娠糖尿病协会标准，低危组参与者的平均（SD）年龄为 30.5±3.7 岁，高危组参与者的平均（SD）年龄为 31.0±3.9 岁。现有的 7-14 周标准的 ROC 曲线下面积（AUC）在 0.705 至 0.724 之间。基于母体年龄、孕前体重指数和早期 OGTT 结果，我们的预测模型的 AUC 为 0.8720，内部（AUC 为 0.8541）和外部（AUC 为 0.8241）验证均验证了其有效性。
现有的诊断标准对 GDM 的早期预测并不理想。通过结合早期 OGTT，我们提供了一种在孕早期预测 GDM 的有效模型。
