Risk Analysis And Prediction Model Construction Of Early Onset Gestational Diabetes Mellitus

Objective: To analyze the risk factors of early onset gestational diabetes mellitus(Early Gestational Diabetes Mellitus,E-GDM)pregnant women and construct a prediction model.Methods: Prospective study.From January 2018 to December 2019,1519 pregnant women were examined in our hospital.The first visit was 4-12 weeks.Basic information on pregnant women including age,body mass index(Body Mass Index,BMI),pregnancy,birth,PCOS,family history of diabetes,conception is collected.Blood glucose changes were observed during follow-up.We need to identify and diagnose gestational diabetes mellitus(Gestational Diabetes Mellitus,GDM)in time by oral Glucose tolerance administration(Oral Glucose Tolerance,OGTT)or fasting blood glucose(Fasting Blood-glucose,FBG).The pregnant women were divided into E-GDM groups(5-23 weeks confirmed GDM)and non E-GDM groups according to the test results and the time of diagnosis.The non E-GDM group included the regular gestational diabetes group(Regular Gestational Diabetes Mellitus,R-GDM)thus24-28 weeks confirmed GDM and normal blood glucose group(Normal Glucose Tolerance,NGT).Then the risk factor analysis and prediction model are constructed.Results: 1519 subjects were divided into E-GDM groups of 272,R-GDM group of250,NGT group of 997.R-GDM group and NGT group are collectively referred to non E-GDM group(n =1247).The results showed that old age,obesity,previous adverse pregnancy outcomes(including pregnant women with hypertension,premature delivery,abortion,neonatal intensive care hospitalization,jaundice,older pregnancy and macrosomia,etc.),the mode of conception as assisted reproduction,previous polycystic ovary syndrome,family history of diabetes,pregnancy ≥3 times were E-GDM risk factors(all P <0.05).correction COX confounding factors revealed that the four variables of old age,obesity,family history of diabetes and previous polycystic ovary syndrome were independent risk factors for E-GDM(all P<0.05).COX regression analysis showed that the above four independent factors increased the risk of E-GDM in pregnant women from 5 weeks of pregnancy,and the cumulative risk of disease increased by 7%,13%,14%,15%(all P <0.05).Building a prognostic risk model from the above four independent risk factors,Prognostic Index(Prognostic index,PI)Quantify the risk score E-GDM each pregnant woman.According to the score,the subjects were divided into four groups,including very low risk group(PI =0,n =377),low risk group(0 <PI ≤1,n =436),middle risk group(1<PI ≤2,n =281),high risk group(PI >2,n =32).By COX regression analysis,we found that compared with the very low risk group,The cumulative risk of pregnant women in low risk group,middle risk group and high risk group E-GDM increased by10%,40% and 60% respectively(all P <0.05).Conclusion: Old age,obesity,family history of diabetes and PCOS are independent risk factors of E-GDM,and the risk prediction model constructed by these four independent factors can predict the risk of pregnant women’s E-GDM by quantitative scoring.