TY - JOUR
T1 - External validation and clinical utility of prognostic prediction models for gestational diabetes mellitus
T2 - A prospective cohort study
AU - Meertens, Linda J. E.
AU - Scheepers, Hubertina C. J.
AU - van Kuijk, Sander M. J.
AU - Roeleveld, Nel
AU - Aardenburg, Robert
AU - van Dooren, Ivo M. A.
AU - Langenveld, Josje
AU - Zwaan, Iris M.
AU - Spaanderman, Marc E. A.
AU - van Gelder, Marleen M. H. J.
AU - Smits, Luc J. M.
N1 - Funding Information:
The Expect Study I was funded by The Netherlands Organization for Health Research and Development, Pregnancy and Childbirth Program (ZonMw grant 209020007). The PRIDE Study did not receive specific funding for this project.
Publisher Copyright:
© 2020 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG)
PY - 2020/7
Y1 - 2020/7
N2 - Introduction We performed an independent validation study of all published first trimester prediction models, containing non-invasive predictors, for the risk of gestational diabetes mellitus. Furthermore, the clinical potential of the best performing models was evaluated. Material and methods Systemically selected prediction models from the literature were validated in a Dutch prospective cohort using data from Expect Study I and PRIDE Study. The predictive performance of the models was evaluated by discrimination and calibration. Clinical utility was assessed using decision curve analysis. Screening performance measures were calculated at different risk thresholds for the best model and compared with current selective screening strategies. Results The validation cohort included 5260 women. Gestational diabetes mellitus was diagnosed in 127 women (2.4%). The discriminative performance of the 12 included models ranged from 68% to 75%. Nearly all models overestimated the risk. After recalibration, agreement between the observed outcomes and predicted probabilities improved for most models. Conclusions The best performing prediction models showed acceptable performance measures and may enable more personalized medicine-based antenatal care for women at risk of developing gestational diabetes mellitus compared with current applied strategies.
AB - Introduction We performed an independent validation study of all published first trimester prediction models, containing non-invasive predictors, for the risk of gestational diabetes mellitus. Furthermore, the clinical potential of the best performing models was evaluated. Material and methods Systemically selected prediction models from the literature were validated in a Dutch prospective cohort using data from Expect Study I and PRIDE Study. The predictive performance of the models was evaluated by discrimination and calibration. Clinical utility was assessed using decision curve analysis. Screening performance measures were calculated at different risk thresholds for the best model and compared with current selective screening strategies. Results The validation cohort included 5260 women. Gestational diabetes mellitus was diagnosed in 127 women (2.4%). The discriminative performance of the 12 included models ranged from 68% to 75%. Nearly all models overestimated the risk. After recalibration, agreement between the observed outcomes and predicted probabilities improved for most models. Conclusions The best performing prediction models showed acceptable performance measures and may enable more personalized medicine-based antenatal care for women at risk of developing gestational diabetes mellitus compared with current applied strategies.
KW - decision curve analysis
KW - external validation
KW - gestational diabetes mellitus
KW - prediction
KW - risk assessment
KW - 1ST TRIMESTER PREDICTION
KW - WEB-BASED QUESTIONNAIRES
KW - RISK
KW - PREVALENCE
KW - PREGNANCY
KW - IMPACT
KW - WOMEN
KW - COST
U2 - 10.1111/aogs.13811
DO - 10.1111/aogs.13811
M3 - Article
C2 - 31955406
SN - 0001-6349
VL - 99
SP - 891
EP - 900
JO - Acta Obstetricia et Gynecologica Scandinavica
JF - Acta Obstetricia et Gynecologica Scandinavica
IS - 7
ER -