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BMJ. 2016 Aug 30;354:i4338. doi: 10.1136/bmj.i4338.

External validation of prognostic models to predict risk of gestational diabetes mellitus in one Dutch cohort: prospective multicentre cohort study.

Author information

1
Department of Obstetrics, Division Woman and Baby, University Medical Centre Utrecht, KE.04.123.1, PO box 85090, 3508 AB, Utrecht, Netherlands m.deruiter-7@umcutrecht.nl.
2
Department of Obstetrics, Division Woman and Baby, University Medical Centre Utrecht, KE.04.123.1, PO box 85090, 3508 AB, Utrecht, Netherlands.
3
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands.
4
Livive, Centre for Obstetrics, Tilburg, Netherlands.
5
Department of Obstetrics, Meander Medical Centre, Amersfoort, Netherlands.
6
Department of Neonatology, Division Woman and Baby, University Medical Centre Utrecht, Utrecht, Netherlands.
7
Department of Obstetrics, Zuwe Hofpoort Hospital, Woerden, Netherlands.
8
Department of Obstetrics, Gelre Hospital, Apeldoorn, Netherlands.
9
Department of Obstetrics, Hospital Rivierenland, Tiel, Netherlands.
10
Department of Obstetrics, St Antonius Hospital, Nieuwegein, Netherlands.
11
Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands.
12
Midwifery practice Verloskundigen Amersfoort, Amersfoort, Netherlands.
13
Department of Obstetrics, St Elisabeth Hospital, Tilburg, Netherlands.
14
Midwifery practice GCM, Maarssenbroek, Netherlands.
15
Midwifery practice Het Wonder, Houten, Netherlands.
16
Netherlands Institute for health services research (NIVEL), Utrecht, Netherlands.
17
Department of Obstetrics, Deventer Hospital, Deventer, Netherlands.
18
Department of Obstetrics, Division Woman and Baby, University Medical Centre Utrecht, KE.04.123.1, PO box 85090, 3508 AB, Utrecht, Netherlands Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands.

Abstract

OBJECTIVE:

 To perform an external validation and direct comparison of published prognostic models for early prediction of the risk of gestational diabetes mellitus, including predictors applicable in the first trimester of pregnancy.

DESIGN:

 External validation of all published prognostic models in large scale, prospective, multicentre cohort study.

SETTING:

 31 independent midwifery practices and six hospitals in the Netherlands.

PARTICIPANTS:

 Women recruited in their first trimester (<14 weeks) of pregnancy between December 2012 and January 2014, at their initial prenatal visit. Women with pre-existing diabetes mellitus of any type were excluded.

MAIN OUTCOME MEASURES:

 Discrimination of the prognostic models was assessed by the C statistic, and calibration assessed by calibration plots.

RESULTS:

 3723 women were included for analysis, of whom 181 (4.9%) developed gestational diabetes mellitus in pregnancy. 12 prognostic models for the disorder could be validated in the cohort. C statistics ranged from 0.67 to 0.78. Calibration plots showed that eight of the 12 models were well calibrated. The four models with the highest C statistics included almost all of the following predictors: maternal age, maternal body mass index, history of gestational diabetes mellitus, ethnicity, and family history of diabetes. Prognostic models had a similar performance in a subgroup of nulliparous women only. Decision curve analysis showed that the use of these four models always had a positive net benefit.

CONCLUSIONS:

 In this external validation study, most of the published prognostic models for gestational diabetes mellitus show acceptable discrimination and calibration. The four models with the highest discriminative abilities in this study cohort, which also perform well in a subgroup of nulliparous women, are easy models to apply in clinical practice and therefore deserve further evaluation regarding their clinical impact.

PMID:
27576867
DOI:
10.1136/bmj.i4338
[Indexed for MEDLINE]
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