Development and validation of a clinical model for preconception and early pregnancy risk prediction of gestational diabetes mellitus in nulliparous women
| Autor: | Larry Rand, Wei Bao, Laura L. Jelliffe-Pawlowski, Audrey F. Saftlas, Rebecca J. Baer, Jennifer G. Robinson, Scott P. Oltman, Knute D. Carter, Patrick Breheny, Brittney M. Donovan, Andrea L. Greiner, Kelli K Ryckman |
|---|---|
| Přispěvatelé: | Beyerlein, Andreas |
| Rok vydání: | 2019 |
| Předmět: |
Male
Reproductive health and childbirth Preconception Care California Body Mass Index Cohort Studies 0302 clinical medicine Risk Factors Pregnancy Models Ethnicity 030212 general & internal medicine Pediatric education.field_of_study screening and diagnosis Multidisciplinary Continental Population Groups Obstetrics Diabetes Pregnancy Outcome Middle Aged Gestational diabetes Parity Detection Cohort Gestational Medicine Female Risk assessment Cohort study 4.2 Evaluation of markers and technologies Adult medicine.medical_specialty Adolescent General Science & Technology Science Population 030209 endocrinology & metabolism Ethnic Groups Prenatal care Models Biological Risk Assessment 03 medical and health sciences Young Adult Clinical Research medicine Humans Conditions Affecting the Embryonic and Fetal Periods education Metabolic and endocrine Nutrition business.industry Prevention Racial Groups Infant Newborn Infant Perinatal Period - Conditions Originating in Perinatal Period medicine.disease Biological Newborn Diabetes Gestational business |
| Zdroj: | PloS one, vol 14, iss 4 PLoS ONE, Vol 14, Iss 4, p e0215173 (2019) |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|