Influencing factors and prediction model construction of adverse pregnancy outcomes in pregnant women with intrahepatic cholestasis of pregnancy complicated with GDM

WANG Xinxin; XU Hui; WU Xiao

doi:10.11958/20242396

Abstract：Objective To analyze the influencing factors of adverse pregnancy outcomes in pregnant women with intrahepatic cholestasis of pregnancy(ICP)complicated with gestational diabetes mellitus(GDM)and to construct a risk prediction model.Methods A total of 214 ICP pregnant women with GDM were selected and divided into the modeling group(n=161)and the verification group(n=53)according to the ratio of 3∶1.Patients in the modeling group were classified into the good outcome group(96 cases)and the poor outcome group(65 cases)by means of pregnancy outcomes.The general clinical data and laboratory indicators were compared between the good outcome group and the poor outcome group.Multivariate Logistic regression analysis was used to analyze risk factors of adverse pregnancy outcomes in pregnant women with ICP complicated with GDM,and a risk prediction model was established.The verification group was used to verify the model.Results Multivariate Logistic regression analysis showed that age≥35 years old,substandard blood glucose management during pregnancy,vaginal microecological disorder in late pregnancy,high total bile acid(TBA)and high interleukin(IL)-12 were independent risk factors of adverse pregnancy outcomes in ICP pregnant women with GDM(P＜0.05).Logistic regression model was constructed based on multivariate results,and Logit(P)=1.338×age+2.196×blood glucose management during pregnancy+2.640×late pregnancy vaginal microecology+0.112×TBA+0.090×IL-12-14.898.Receiver operating characteristic(ROC)curve analysis indicated that the area under the curve(AUC)value,sensitivity and specificity of the prediction model were 0.930,89.23%and 83.33%.Hosmer-Lemeshow goodness of fit test revealed χ2=4.625 and P=0.797.The AUC,sensitivity and specificity for external validation of the model were 0.939,80.95%and 96.87%,and Hosmer-Lemeshow goodness of fit test indicated χ2=6.379 and P=0.605.Conclusion The factors of adverse pregnancy outcomes in pregnant women with ICP complicated with GDM include age,blood glucose management during pregnancy,vaginal microecology in late pregnancy,TBA and IL-12,and the established risk prediction model based on the above factors has good predictive efficiency.