External validation and clinical utility of prognostic prediction models for gestational diabetes mellitus: A prospective cohort study
Linda J. E. Meertens, Hubertina Scheepers, Sander M. J. van Kuijk, Nel Roeleveld, Robert Aardenburg, Ivo M.A. van Dooren, Josje Langenveld, Iris M. Zwaan, Marc E. A. Spaanderman, Marleen M. H. J. van Gelder, Luc Smits
Abstract
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.