External validation of prognostic models to predict risk of gestational diabetes mellitus in one Dutch cohort: prospective multicentre cohort study
Open accessAbstract
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.
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Missing values were imputed using multiple imputation, with ten imputations, and Rubin's rules were applied to combine results.
“Missing values were imputed using multiple imputation [22, 33]. All variables and outcomes were used in the imputation model and ten imputations were performed. The results shown are the results after multiple imputation. Rubin’s rules were applied to combine the results into summary estimates [34].”
From Associations between periconceptional lifestyle behaviours and adverse pregnancy outcomes (2021) · cites this paper as [22]
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- Authors
- Lamain-de Ruiter, M., Kwee, A., Naaktgeboren, C. A., de Groot, I., Evers, I. M., Groenendaal, F., Hering, Y. R., Huisjes, A. J. M., Kirpestein, C., Monincx, W. M., Siljee, J. E., Van ’t Zelfde, A., van Oirschot, C. M., Vankan-Buitelaar, S. A., Vonk, M. A. A. W., Wiegers, T. A., Zwart, J. J., Franx, A., Moons, K. G. M., & Koster, M. P. H.
- Affiliations
- University Medical Center Utrecht (NL)
- Meander Medisch Centrum (NL)
- Gelre Hospitals (NL)
- Ziekenhuis Rivierenland (NL)
- St. Antonius Ziekenhuis (NL)
- National Institute for Public Health and the Environment (NL)
- Netherlands Institute for Health Services Research (NL)
- Deventer Ziekenhuis (NL)
- Erasmus MC (NL)
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2016-08-30
- Volume
- 354
- Pages
- i4338
- ISSN
- 1756-1833 (ISSN-L)
- OpenAlex
- W2507949452
- Cited by
- 123
- References
- 10
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 10 · 2023: 17 · 2022: 9 · 2021: 18 · 2020: 17 · 2019: 16 · 2018: 12 · 2017: 5 · 2016: 1
- FWCI
- 14.59
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion)
- Funders
- ZonMw (50-50200-98-060)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Keywords
- gestational diabetes mellitus, prognostic model, external validation, risk prediction, first trimester, model discrimination, model calibration, maternal age, body mass index, family history of diabetes, nulliparous women, decision curve analysis
- MeSH terms
- Adult, Calibration, Diabetes Mellitus, Female, Humans, Maternal Age, Netherlands, Parity, Predictive Value of Tests, Pregnancy, Pregnancy Trimester, First, Prospective Studies, Risk Factors, Statistics as Topic, Body Mass Index, Diabetes, Gestational, Risk Assessment
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