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Open AccessReview

The Unrealised Potential for Predicting Pregnancy Complications in Women with Gestational Diabetes: A Systematic Review and Critical Appraisal

1
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3800, Australia
2
Diabetes Unit, Monash Health, Clayton, VIC 3168, Australia
3
Barts Research Centre for Women’s Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
4
Multidisciplinary Evidence Synthesis Hub, Queen Mary University of London, London E1 2AB, UK
5
Monash Women’s Program, Monash Health, Clayton, VIC 3168, Australia
*
Authors to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(9), 3048; https://doi.org/10.3390/ijerph17093048
Received: 12 March 2020 / Revised: 21 April 2020 / Accepted: 22 April 2020 / Published: 27 April 2020
(This article belongs to the Special Issue Current Trends in Health and Disease)
Gestational diabetes (GDM) increases the risk of pregnancy complications. However, these risks are not the same for all affected women and may be mediated by inter-related factors including ethnicity, body mass index and gestational weight gain. This study was conducted to identify, compare, and critically appraise prognostic prediction models for pregnancy complications in women with gestational diabetes (GDM). A systematic review of prognostic prediction models for pregnancy complications in women with GDM was conducted. Critical appraisal was conducted using the prediction model risk of bias assessment tool (PROBAST). Five prediction modelling studies were identified, from which ten prognostic models primarily intended to predict pregnancy complications related to GDM were developed. While the composition of the pregnancy complications predicted varied, the delivery of a large-for-gestational age neonate was the subject of prediction in four studies, either alone or as a component of a composite outcome. Glycaemic measures and body mass index were selected as predictors in four studies. Model evaluation was limited to internal validation in four studies and not reported in the fifth. Performance was inadequately reported with no useful measures of calibration nor formal evaluation of clinical usefulness. Critical appraisal using PROBAST revealed that all studies were subject to a high risk of bias overall driven by methodologic limitations in statistical analysis. This review demonstrates the potential for prediction models to provide an individualised absolute risk of pregnancy complications for women affected by GDM. However, at present, a lack of external validation and high risk of bias limit clinical application. Future model development and validation should utilise the latest methodological advances in prediction modelling to achieve the evolution required to create a useful clinical tool. Such a tool may enhance clinical decision-making and support a risk-stratified approach to the management of GDM. Systematic review registration: PROSPERO CRD42019115223. View Full-Text
Keywords: gestational diabetes; prediction; risk; prognosis; pregnancy complications; large-for-gestational age; neonatal hypoglycaemia; pre-eclampsia; shoulder dystocia; systematic review gestational diabetes; prediction; risk; prognosis; pregnancy complications; large-for-gestational age; neonatal hypoglycaemia; pre-eclampsia; shoulder dystocia; systematic review
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MDPI and ACS Style

Cooray, S.D.; Wijeyaratne, L.A.; Soldatos, G.; Allotey, J.; Boyle, J.A.; Teede, H.J. The Unrealised Potential for Predicting Pregnancy Complications in Women with Gestational Diabetes: A Systematic Review and Critical Appraisal. Int. J. Environ. Res. Public Health 2020, 17, 3048. https://doi.org/10.3390/ijerph17093048

AMA Style

Cooray SD, Wijeyaratne LA, Soldatos G, Allotey J, Boyle JA, Teede HJ. The Unrealised Potential for Predicting Pregnancy Complications in Women with Gestational Diabetes: A Systematic Review and Critical Appraisal. International Journal of Environmental Research and Public Health. 2020; 17(9):3048. https://doi.org/10.3390/ijerph17093048

Chicago/Turabian Style

Cooray, Shamil D.; Wijeyaratne, Lihini A.; Soldatos, Georgia; Allotey, John; Boyle, Jacqueline A.; Teede, Helena J. 2020. "The Unrealised Potential for Predicting Pregnancy Complications in Women with Gestational Diabetes: A Systematic Review and Critical Appraisal" Int. J. Environ. Res. Public Health 17, no. 9: 3048. https://doi.org/10.3390/ijerph17093048

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