Abstract
OBJECTIVE: To explore the related factors of spontaneous premature birth (SPB) in pregnant women with gestational diabetes mellitus (GDM), and to construct its nomogram risk prediction model. METHODS: A retrospective collection of clinical data was conducted on 410 GDM patients admitted to our hospital from October 2020 to October 2023 as the training set. In addition, clinical data of 144 GDM patients admitted to our hospital from November 2023 to September 2024 retrospectively were collected as the validation cohort set for external validation. Both groups were separated into SPB group and non-SPB group based on whether SPB occurred. RESULTS: Logistic analysis of training set showed that age, pre-pregnancy BMI, history of spontaneous abortion, history of infection during pregnancy, family history of diabetes, hypertension, and premature rupture of membranes were the risk factors for SPB in GDM pregnant women (P < 0.05). The AUC of the ROC curve for the discrimination of the training set was 0.850, the optimism-corrected C-index was 0.753,and the H-L test showed χ(2) = 6.987 (P = 0.699). DCA curve showed that when the threshold probability was between 0.13 and 0.99, the model had high clinical application value. The external validation results showed that the AUC of the ROC curve was 0.891, the optimism-corrected C-index was 0.771, and the H-L test showed χ(2) = 7.016 (P = 0.699), and the threshold probability of the DCA curve results was between 0.11 and 0.87, indicating that the model had high clinical application value. CONCLUSION: Age, pre-pregnancy BMI, history of spontaneous abortion, history of infection during pregnancy, family history of diabetes, hypertension, and premature rupture of membranes are the risk factors for SPB in GDM pregnant women. The nomogram prediction model constructed based on these factors has good calibration and discrimination.