Risk assessment and prediction model construction of pregnant women with IVF-ET and GDM
Objective To explore the adverse pregnancy outcomes of gestational diabetes mellitus (GDM) patients with different conception methods,and to construct a risk prediction model.Methods A ret-rospective cohort study was carried out to analyze the clinical data of 1453 cases of GDM patients who re-ceived regular prenatal care and delivery in the obstetrics department of the First People's Hospital of Yunnan Province from January 2018 to August 2022.A total of 436 patients with GDM who underwent in vitro fertili-zation-embryo transfer (IVF-ET) were served as the observation group,1017 GDM patients with natural ges-tation during the same period were selected as the control group.Chi-square test and t-test were used to com-pare the basic data,weight change,blood glucose reaching standard rate,maternal and infant pregnancy out-comes and related complications between the two group.The risk factors causing adverse pregnant outcomes were analyzed after controlling the confounding variables by adopting multivariate logistic regression.The pre-diction model was constructed according to the regression coefficient weight of each risk factor.The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the predictive efficiency of each independent risk factor and combined predictive factors.Results IVF-ET was an independ-ent risk factor for the first cesarean section (OR=1.809,95%CI:1.339-2.442),preterm birth (OR=1.622,95%CI:1.090-2.413),postpartum hemorrhage (OR=2.377,95%CI:1.406-4.018),adherent placenta (OR=1.971,95%CI:1.211-3.209),low birth weight infant (OR=2.232,95%CI:1.354-3.680) in the pa-tients with GDM (P<0.05).A combined prediction model was established by parity,age,fetus number,ges-tational weight gain,IVF-ET and scar uterus.The combined prediction probability was P=eLogit(P)/(1+eLogit(P)),Logit(P)=β1X1+β2X2+…+βnXn.The combined prediction efficacy of this study model for pre-term birth,cesarean section and low birth weight infants was good,AUC was approximately 0.8,which was greater than AUC of each independent risk factor.Conclusion The combined model of parity,age,fetus num-ber,gestational weight gain,IVF-ET and scar uterus has a certain predictive value for the risk of cesarean sec-tion,preterm birth and low birth weight infant in the patients with GDM.
in vitro fertilization-embryo transfergestational diabetes mellituspregnancy outcomesrisk factorsprediction
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