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| Estabilish of the risk model of the high-risk factors of the adverse neonatal outcomes of women with gestational diabetes mellitus |
| Jinan Fourth People's Hospital, Jinan, Shandong Province, 250031 |
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Abstract To explore the high-risk factors of the adverse neonatal outcomes of pregnant women with gestational diabetes mellitus(GDM), and to establish a Logistic risk model. Methods: The clinical data of 196 pregnant women with GDM who were admitted to the obstetrics clinic of the hospital from February 2020 to August 2022 were selected. According to the neonatal outcomes, these women were divided into study group(women with adverse neonatal outcomes) and control group(women without adverse neonatal outcomes). Logistic regression analysis was used to determine the high-risk factors of the adverse neonatal outcomes of the pregnant women with GDM, and Logistic risk model was established. Hosmer-Lemeshow test was used to determine the goodness of fit of the risk model. Receiver operating characteristic(ROC) curve was used to explore the predictive effect of this risk model. Results: Among 168 pregnant women, there were 44 cases with adverse neonatal outcomes and 124 cases without adverse neonatal outcomes. There were significant differences in the hypertensive disorders complicating pregnancy occurrence, the depressive symptoms, the pre-pregnancy BMI value, the weight gain during pregnancy, and the levels of fasting plasma glucose(FPG), 1-hour plasma glucose(1h PG) and glycosylated hemoglobin(HbA1c) before delivery of the women between the two groups. Logistic regression analysis showed that the hypertensive disorders complicating pregnancy, the depressive symptoms, the excessive weight gain during pregnancy and the high HbA1c level before delivery of the women with GDM were the independent risk factors of their adverse neonatal outcomes(all P<0.05). A logistic risk model was established based on these independent risk factors, which was Logit(P)=-15.610+1.472× hypertensive disorder complicating pregnancy(yes=1, no=0)+0.884×depressive symptoms(yes=1, no=0)+1.014×weight gain during pregnancy(excessive weight gain=2, insufficient weight gain=1). Normal weight gain during pregnancy=0)+2.053×HbA1c(%) before delivery. Hosmer-Lemeshow test(χ2=9.952, P=0.268) had a good goodness of fit for this model. ROC curve showed that the area under the curve of this logistic risk model for predicting the adverse neonatal outcomes of the pregnant women with GDM was 0.792, 95%CI=0.707-0.877, the best predictive sensitivity and specificity of this logistic risk model for the adverse neonatal outcomes were 77.3% and 72.6%. Conclusion: The high-risk factors of the adverse neonatal outcomes of the pregnant women with GDM include the hypertensive disorders complicating pregnancy, the depressive symptoms, the excessive weight gain during pregnancy and the high HbA1 c level before delivery. The Logistic risk model established by these high-risk factors of the adverse neonatal outcomes has a good predictive effect, and which can provide evidences for clinical intervention.
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