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

doi:10.11958/20242396

Abstract

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.

Key words: cholestasis, intrahepatic, diabetes, gestational, pregnancy outcome, risk factors, Logistic models, ROC curve, nomograms

CLC Number:

R714

Figures/Tables 9

References 24

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组别	n	年龄≥35岁	民族		产妇类型		孕前BMI≥ 24.0 kg/m²	早发型ICP	妊娠期血糖管理未达标
组别	n	年龄≥35岁	汉族	其他民族	初产妇	经产妇	孕前BMI≥ 24.0 kg/m²	早发型ICP	妊娠期血糖管理未达标
结局良好组	96	8（8.3）	91（94.8）	5（5.2）	40（41.7）	56（58.3）	16（16.7）	8（8.3）	9（9.4）
结局不良组	65	26（40.0）	61（93.8）	4（6.2）	31（47.7）	34（52.3）	15（23.1）	12（18.5）	22（33.9）
χ²		23.331^＊＊	0.066		0.571		1.024	3.654	14.928^＊＊

组别	n	年龄≥35岁	民族		产妇类型		孕前BMI≥ 24.0 kg/m²	早发型ICP	妊娠期血糖管理未达标
组别	n	年龄≥35岁	汉族	其他民族	初产妇	经产妇	孕前BMI≥ 24.0 kg/m²	早发型ICP	妊娠期血糖管理未达标
结局良好组	96	8（8.3）	91（94.8）	5（5.2）	40（41.7）	56（58.3）	16（16.7）	8（8.3）	9（9.4）
结局不良组	65	26（40.0）	61（93.8）	4（6.2）	31（47.7）	34（52.3）	15（23.1）	12（18.5）	22（33.9）
χ²		23.331^＊＊	0.066		0.571		1.024	3.654	14.928^＊＊

组别		n		TBA/（μmol/L）			ALT/（U/L）			AST/（U/L）			TBIL/（μmol/L）				TNF-α/（ng/L）			IFN-γ/（ng/L）
结局良好组		96		33.65±8.67			90.91±7.33			61.95±7.63			17.93±1.78				89.82±12.94			167.92±16.82
结局不良组		65		47.35±10.81			96.79±7.27			63.68±5.00			18.18±2.32				91.87±15.23			169.88±22.71
t				8.899^＊＊			5.012^＊＊			1.737			0.756				0.919			0.594
组别			IL-12/（ng/L）			FIB/（g/L）			D-D/（mg/L）			WBC/（×10⁹/L）				NEU/（×10⁹/L）			PLT/（×10⁹/L）
结局良好组			40.68±10.07			4.67±0.74			0.92±0.26			9.06±1.20				6.71±1.32			166.92±31.21
结局不良组			51.45±5.34			4.83±0.60			0.97±0.29			9.32±1.39				6.97±0.47			159.65±29.66
t			8.809^＊＊			1.452			1.032			1.291				1.738			1.479
组别	阴道微生态失调							ACA/CU							β2GP Ⅰ/CU
组别	妊娠早期				妊娠晚期			IgG			IgM			IgA	IgG			IgM			IgA
结局良好组	8（8.3）				9（9.4）			8.28±1.54			8.59±1.33			8.20±1.34	8.25±0.89			8.37±1.34			8.54±1.19
结局不良组	10（15.4）				19（29.2）			8.61±1.01			8.66±0.92			8.29±0.93	8.48±0.76			8.52±0.85			8.60±0.84
χ²或t	1.941				10.636^＊＊			1.661			0.391			0.506	1.668			0.856			0.418

组别		n		TBA/（μmol/L）			ALT/（U/L）			AST/（U/L）			TBIL/（μmol/L）				TNF-α/（ng/L）			IFN-γ/（ng/L）
结局良好组		96		33.65±8.67			90.91±7.33			61.95±7.63			17.93±1.78				89.82±12.94			167.92±16.82
结局不良组		65		47.35±10.81			96.79±7.27			63.68±5.00			18.18±2.32				91.87±15.23			169.88±22.71
t				8.899^＊＊			5.012^＊＊			1.737			0.756				0.919			0.594
组别			IL-12/（ng/L）			FIB/（g/L）			D-D/（mg/L）			WBC/（×10⁹/L）				NEU/（×10⁹/L）			PLT/（×10⁹/L）
结局良好组			40.68±10.07			4.67±0.74			0.92±0.26			9.06±1.20				6.71±1.32			166.92±31.21
结局不良组			51.45±5.34			4.83±0.60			0.97±0.29			9.32±1.39				6.97±0.47			159.65±29.66
t			8.809^＊＊			1.452			1.032			1.291				1.738			1.479
组别	阴道微生态失调							ACA/CU							β2GP Ⅰ/CU
组别	妊娠早期				妊娠晚期			IgG			IgM			IgA	IgG			IgM			IgA
结局良好组	8（8.3）				9（9.4）			8.28±1.54			8.59±1.33			8.20±1.34	8.25±0.89			8.37±1.34			8.54±1.19
结局不良组	10（15.4）				19（29.2）			8.61±1.01			8.66±0.92			8.29±0.93	8.48±0.76			8.52±0.85			8.60±0.84
χ²或t	1.941				10.636^＊＊			1.661			0.391			0.506	1.668			0.856			0.418

变量	非标准化系数		标准化系数	t	P	VIF
变量	β	标准误	Beta	t	P	VIF
年龄	0.149	0.075	0.124	1.973	0.050	1.253
妊娠期血糖管理	0.247	0.072	0.198	3.432	0.001	1.067
TBA	0.013	0.003	0.311	4.205	<0.001	1.742
ALT	0.007	0.004	0.107	1.754	0.081	1.190
IL-12	0.012	0.003	0.241	3.471	0.001	1.540
妊娠晚期阴道微生态	0.320	0.074	0.247	4.313	<0.001	1.048