Purpose of Review

Despite the crucial role that prediction models play in guiding early risk stratification and timely intervention to prevent type 2 diabetes after gestational diabetes mellitus (GDM), their use is not widespread in clinical practice. The purpose of this review is to examine the methodological characteristics and quality of existing prognostic models predicting postpartum glucose intolerance following GDM.

Recent Findings.

A systematic review was conducted on relevant risk prediction models, resulting in 15 eligible publications from research groups in various countries. Our review found that traditional statistical models were more common than machine learning models, and only two were assessed to have a low risk of bias. Seven were internally validated, but none were externally validated. Model discrimination and calibration were done in 13 and four studies, respectively. Various predictors were identified, including body mass index, fasting glucose concentration during pregnancy, maternal age, family history of diabetes, biochemical variables, oral glucose tolerance test, use of insulin in pregnancy, postnatal fasting glucose level, genetic risk factors, hemoglobin A1c, and weight.

Summary

The existing prognostic models for glucose intolerance following GDM have various methodological shortcomings, with only a few models being assessed to have low risk of bias and validated internally. Future research should prioritize the development of robust, high-quality risk prediction models that follow appropriate guidelines, in order to advance this area and improve early risk stratification and intervention for glucose intolerance and type 2 diabetes among women who have had GDM.

中文翻译：

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预测有妊娠糖尿病史的女性产后葡萄糖不耐症的模型：系统评价

审查目的

尽管预测模型在指导早期风险分层和及时干预以预防妊娠糖尿病 (GDM) 后发生 2 型糖尿病方面发挥着至关重要的作用，但其在临床实践中的应用并不广泛。本综述的目的是检查预测 GDM 后产后葡萄糖耐受不良的现有预后模型的方法学特征和质量。

最近的发现。

对相关风险预测模型进行了系统审查，各国研究小组发表了 15 篇符合条件的出版物。我们的审查发现，传统统计模型比机器学习模型更常见，并且只有两种模型被评估为具有低偏倚风险。七个经过内部验证，但没有一个经过外部验证。分别在 13 项和 4 项研究中进行了模型判别和校准。确定了各种预测因素，包括体重指数、怀孕期间空腹血糖浓度、母亲年龄、糖尿病家族史、生化变量、口服葡萄糖耐量试验、怀孕期间使用胰岛素、产后空腹血糖水平、遗传风险因素、血红蛋白 A1c、和重量。

概括

GDM 后葡萄糖不耐症的现有预后模型存在各种方法学缺陷，只有少数模型被评估为具有低偏倚风险并进行了内部验证。未来的研究应优先开发遵循适当指南的稳健、高质量的风险预测模型，以推进这一领域的发展，并改善患有 GDM 的女性中葡萄糖不耐受和 2 型糖尿病的早期风险分层和干预。