Predicting progression from gestational diabetes to impaired glucose
tolerance using peri-delivery data: an observational study
Abstract
Objective: To develop a predictive model to identify women with recent
gestational diabetes (GDM) most likely to progress to impaired glucose
tolerance postpartum. Design: Observational study. Setting: Academic
medical center in the United States. Population: Postpartum women with
recent GDM, defined by Carpenter-Coustan criteria & 1-year postpartum
HbA1c assessment. Methods: We used lasso regression with k-fold cross
validation to develop a multivariable model to predict progression to
impaired glucose tolerance, defined as HbA1c ≥ 5.7%, by 1 year
postpartum. Predictive ability was assessed by the area under the curve,
sensitivity, specificity, positive and negative predictive values. Main
Outcome Measures: Impaired glucose tolerance. Results: Of 203 women,
71(35%) had impaired glucose tolerance at 1 year postpartum. The final
model had an AUC of 0.81 (95% CI 0.74, 0.87) and included eight
indicators of weight, body mass index, Hispanic ethnicity, GDM in a
prior pregnancy, GDM diagnosis < 24 weeks’ gestation, and
fasting and 2-hour plasma glucose at 2 days postpartum. A cut-point of ≥
0.24 predicted probability had sensitivity 80% (95% CI 69, 89),
specificity 58% (95% CI 49, 66), PPV 57% (95% CI 46, 68) and NPV
83% (95% CI 74, 89) to identify women with impaired glucose tolerance
at 1 year postpartum. Conclusions: Our predictive model had reasonable
ability to predict impaired glucose tolerance around delivery for women
with recent GDM. Funding: National Institute of Mental Health and
American Diabetes Association. Keywords: gestational diabetes, impaired
glucose tolerance, type 2 diabetes prevention; predictive model