The unrealised potential for predicting pregnancy complications in women with gestational diabetes: A systematic review and critical appraisal

Shamil D. Cooray, Lihini A. Wijeyaratne, Georgia Soldatos, John Allotey, Jacqueline A. Boyle, Helena J. Teede

Research output: Contribution to journalReview ArticleResearchpeer-review

11 Citations (Scopus)


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.

Original languageEnglish
Article number3048
Number of pages20
JournalInternational Journal of Environmental Research and Public Health
Issue number9
Publication statusPublished - 27 Apr 2020


  • Gestational diabetes
  • Large-for-gestational age
  • Neonatal hypoglycaemia
  • Pre-eclampsia
  • Prediction
  • Pregnancy complications
  • Prognosis
  • Risk
  • Shoulder dystocia
  • Systematic review

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