title: Gestational diabetes: development of an early risk prediction tool to facilitate opportunities for prevention.
abstract: OBJECTIVE
  In the setting of advancing maternal age, escalating obesity and increasing Gestational Diabetes Mellitus (GDM) rates, we aimed to develop a novel risk prediction tool to identify high-risk women in early pregnancy, specifically to facilitate targeted antenatal prevention of GDM.
  
  
  METHODS
  In this retrospective, observational study, first-trimester data collected routinely by midwifery staff in 4276 women attending a large tertiary hospital in 2007/2008 was analysed to examine predictive factors for GDM. GDM was diagnosed with a 28-week oral glucose tolerance test. The data set included a derivation group (n=2880, from 2007 deliveries) and a validation group (n = 1396, from 2008). Multivariate analysis generated a scoring system.
  
  
  RESULTS
  GDM was significantly correlated with a number of factors: past history of GDM, increasing maternal age and body mass index, Asian descent and family history of diabetes. Validation group clinical scores achieved a sensitivity of 61.3% and specificity of 71.4% for differentiating women according to their risk of developing GDM.
  
  
  CONCLUSIONS
  Risk factors for GDM are easily identified at the first-trimester midwifery hospital booking visit. A risk prediction tool, derived from risk factors in early pregnancy, identifies women at high risk of GDM. This represents a novel approach to facilitate targeted early intervention with the potential to prevent development of, or ameliorate, GDM.
authors.affiliation: Jean Hailes Foundation for Women's Health, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia. Helena.Teede@monash.edu
authors.forename: Helena J
authors.initials: HJ
authors.lastname: Teede
authors.forename: Cheryce L
authors.initials: CL
authors.lastname: Harrison
authors.forename: Wan T
authors.initials: WT
authors.lastname: Teh
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Allan
mesh_terms: D000328:Adult; D019540:Area Under Curve; D044466:Asian People; D015992:Body Mass Index; D003661:Decision Support Techniques; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000235:genetics / Q000517:prevention & control*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008403:Mass Screening; D008423:Maternal Age; D015999:Multivariate Analysis; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011295:Prenatal Care; D015995:Prevalence; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult