External validation and clinical utility of prognostic prediction models for gestational diabetes mellitus: A prospective cohort study.
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.
['Meertens|Linda J E|LJE|0000-0002-4154-7737', 'Scheepers|Hubertina C J|HCJ|', 'van Kuijk|Sander M J|SMJ|', 'Roeleveld|Nel|N|', 'Aardenburg|Robert|R|', 'van Dooren|Ivo M A|IMA|', 'Langenveld|Josje|J|', 'Zwaan|Iris M|IM|', 'Spaanderman|Marc E A|MEA|', 'van Gelder|Marleen M H J|MMHJ|', 'Smits|Luc J M|LJM|']
D000328:Adult D000465:Algorithms D016640:Diabetes, Gestational D005260:Female D006801:Humans D015233:Models, Statistical D009426:Netherlands D011237:Predictive Value of Tests D011247:Pregnancy D011336:Probability D011379:Prognosis D011446:Prospective Studies D018570:Risk Assessment D012307:Risk Factors
external validation prediction gestational diabetes mellitus decision curve analysis risk assessment