Early prediction of gestational diabetes mellitus using maternal demographic and clinical risk factors.

OBJECTIVE: To build and validate an early risk prediction model for gestational diabetes mellitus (GDM) based on first-trimester electronic medical records including maternal demographic and clinical risk factors. METHODS: To develop and validate a GDM prediction model, two datasets were used in this retrospective study. One included data of 14,015 pregnant women from Máxima Medical Center (MMC) in the Netherlands. The other was from an open-source database nuMoM2b including data of 10,038 nulliparous pregnant women, collected in the USA. Widely used maternal demographic and clinical risk factors were considered for modeling. A GDM prediction model based on elastic net logistic regression was trained from a subset of the MMC data. Internal validation was performed on the remaining MMC data to evaluate the model performance. For external validation, the prediction model was tested on an external test set from the nuMoM2b dataset. RESULTS: An area under the receiver-operating-characteristic curve (AUC) of 0.81 was achieved for early prediction of GDM on the MMC test data, comparable to the performance reported in previous studies. While the performance markedly decreased to an AUC of 0.69 when testing the MMC-based model on the external nuMoM2b test data, close to the performance trained and tested on the nuMoM2b dataset only (AUC = 0.70).

Feature selection for unbiased imputation of missing values: A case study in healthcare.

Datasets in healthcare are plagued with incomplete information. Imputation is a common method to deal with missing data where the basic idea is to substitute some reasonable guess for each missing value and then continue with the analysis as if there were no missing data. However unbiased predictions based on imputed datasets can only be guaranteed when the missing mechanism is completely independent of the observed or missing data. Often, this promise is broken in healthcare dataset acquisition due to unintentional errors or response bias of the interviewees. We highlight this issue by studying extensively on an annual health survey dataset on infant mortality prediction and provide a systematic testing for such assumption. We identify such biased features using an empirical approach and show the impact of wrongful inclusion of these features on the predictive performance.Clinical relevance- We show that blind analysis along with plug and play imputation of healthcare data is a potential pitfall that clinicians and researchers want to avoid in finding important markers of disease.