Analysis on the risk factors and risk model construction of neonatal hypoglycemia delivered by pregnants with gestational diabetes mellitus

ObjectiveTo explore the influencing factors of hypoglycemia newborns delivered by pregnants with gestational diabetes mellitus(GDM), and construct a risk prediction model.

MethodsThe clinical data of 479 GDM pregnants with regular obstetric check-ups and their newborns were retrospectively analyzed.According to the blood glucose level of newborns delivered by GDM pregnants, the newborns were divided into the hypoglycemia group(n=71) and normal group(n=408).The clinical data between two groups were compared.Multivariate logistic regression was used to analyze the influencing factors of hypoglycemia in newborns delivered by GDM pregnants with.The nomogram model was drawn using R3.4.3 software, and the receiver operating characteristic(ROC) curve was used to evaluate the discrimination of the nomogram model.The predictive performance of the nomogram model in 1 000 samples was verified using the repeated sampling method(Bootstrap).

ResultsThe differences of the gestational week, prenatal BMI, fetal body mass, prenatal training, blood glucose during delivery and delivery mode between two groups were statistically significant(P < 0.05 to P < 0.01).The results of multivariate logistic regression analysis showed that the pregnant women with high prenatal BMI(OR=1.887, 95%CI: 1.215-3.454), poor blood glucose control during delivery(OR=2.581, 95%CI: 1.762-5.283) and cesarean section(OR=1.889, 95%CI: 1.274-3.548) were the risk factors of neonatal hypoglycemia in GDM mothers(P < 0.01).The long gestational week of puerpura(OR=0.488, 95%CI: 0.274-0.892), estimating the heavy fetal body mass(OR=0.472, 95%CI: 0.171-0.895) and more maternal prenatal training(OR=0.558, 95%CI: 0.215-0.781) were the protective factorsof neonatal hypoglycemia delivered by GDM mothers(P < 0.05 to P < 0.01).Based on the above six indicators, the nomogram prediction model was constructed.The results of ROC curve analysis showed that the AUC area of the nomogram model predicting the risk of hypoglycemia in newborns delivered by GDM mothers was 0.869(95%CI: 0.815-0.906), which indicated that the discrimination ability of model was good.The results of Bootstrap test shows that the MAE of deviation calibration curve was 0.015, which indicated that the deviation calibration curve fit well with the ideal curve.

ConclusionsIt is of certain value to construct a predictive model of hypoglycemia risk of neonates delivered by GDM pregnants based on gestational age, prenatal BMI, fetal weight, prenatal training, blood glucose during delivery and delivery methods.