Development and validation of a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for the screening of high-risk pregnant women for gestational diabetes mellitus in Pakistan
Introduction The prevalence of gestational diabetes mellitus (GDM) is on the rise in low-income and middle-income countries, such as Pakistan. Therefore, the development of a risk score that is simple, affordable and easy to administer is needed. Our study aimed to develop a Non-INvaSive Pregnancy R...
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BMJ Publishing Group
2024-04-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/2/1/e000920.full |
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| author | Romaina Iqbal Iqbal Azam Subhash Chandir Rahat Qureshi Ali Jaffar Neelofur Babar Sabahat Naz Samreen Jamal Aisha Syed Wali |
| author_facet | Romaina Iqbal Iqbal Azam Subhash Chandir Rahat Qureshi Ali Jaffar Neelofur Babar Sabahat Naz Samreen Jamal Aisha Syed Wali |
| author_sort | Romaina Iqbal |
| collection | DOAJ |
| description | Introduction The prevalence of gestational diabetes mellitus (GDM) is on the rise in low-income and middle-income countries, such as Pakistan. Therefore, the development of a risk score that is simple, affordable and easy to administer is needed. Our study aimed to develop a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for GDM screening in Pakistani pregnant women based on risk factors reported in the literature.Methods Using a cross-sectional study design, we enrolled 500 pregnant women who attended antenatal clinics at one tertiary and two secondary care hospitals in Karachi between the 28th and 32nd weeks of gestation. We randomly divided data into derivation (n=404; 80%) and validation datasets (n=96; 20%). We conducted interviews to collect information on sociodemographic factors and family history of diabetes, measured mid-upper arm circumference (MUAC) and reviewed the medical records of women for obstetric history and oral glucose tolerance test (OGTT) results. We performed a multivariable logistic regression analysis to obtain coefficients of selected predictors for GDM in the derivation dataset. Calibration was estimated using Pearson’s χ2 goodness of fit test while discrimination was checked using the area under the curve (AUC) in the validation dataset.Results Overall, the GDM prevalence was 26% (n=130). INSPIRE was based on six predictors: maternal age, MUAC, family history of diabetes, a history of GDM, previous bad obstetrical outcome and a history of macrosomia. INSPIRE achieved a good calibration (Pearson’s χ2=29.55, p=0.08) and acceptable discrimination with an AUC of 0.721 (95% CI 0.61 to 0.83) with a sensitivity of 74.1% and specificity of 59.4% in the validation dataset.Conclusion We developed and validated an INSPIRE that efficiently differentiates Pakistani pregnant women at high risk of GDM from those at low risk, thus reducing the unnecessary burden of the OGTT test. |
| format | Article |
| id | doaj-art-118d7ae9a59e4e28b9ab003eabb7aa9d |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Public Health |
| spelling | doaj-art-118d7ae9a59e4e28b9ab003eabb7aa9d2025-01-28T19:10:11ZengBMJ Publishing GroupBMJ Public Health2753-42942024-04-012110.1136/bmjph-2024-000920Development and validation of a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for the screening of high-risk pregnant women for gestational diabetes mellitus in PakistanRomaina Iqbal0Iqbal Azam1Subhash Chandir2Rahat Qureshi3Ali Jaffar4Neelofur Babar5Sabahat Naz6Samreen Jamal7Aisha Syed Wali8Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan3 Department of Community Health Sciences, Aga Khan University, Karachi, PakistanDepartment of Community Health Sciences, The Aga Khan University, Karachi, PakistanDepartment of Obstetrics and Gynecology, The Aga Khan University, Karachi, PakistanNational Institute of Cardiovascular Diseases, Karachi, PakistanThe Aga Khan Hospital Karimabad, Karimabad, PakistanDepartment of Community Health Sciences, The Aga Khan University, Karachi, PakistanDepartment of Community Health Sciences, The Aga Khan University, Karachi, PakistanAga Khan Hospital Garden, Karachi, PakistanIntroduction The prevalence of gestational diabetes mellitus (GDM) is on the rise in low-income and middle-income countries, such as Pakistan. Therefore, the development of a risk score that is simple, affordable and easy to administer is needed. Our study aimed to develop a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for GDM screening in Pakistani pregnant women based on risk factors reported in the literature.Methods Using a cross-sectional study design, we enrolled 500 pregnant women who attended antenatal clinics at one tertiary and two secondary care hospitals in Karachi between the 28th and 32nd weeks of gestation. We randomly divided data into derivation (n=404; 80%) and validation datasets (n=96; 20%). We conducted interviews to collect information on sociodemographic factors and family history of diabetes, measured mid-upper arm circumference (MUAC) and reviewed the medical records of women for obstetric history and oral glucose tolerance test (OGTT) results. We performed a multivariable logistic regression analysis to obtain coefficients of selected predictors for GDM in the derivation dataset. Calibration was estimated using Pearson’s χ2 goodness of fit test while discrimination was checked using the area under the curve (AUC) in the validation dataset.Results Overall, the GDM prevalence was 26% (n=130). INSPIRE was based on six predictors: maternal age, MUAC, family history of diabetes, a history of GDM, previous bad obstetrical outcome and a history of macrosomia. INSPIRE achieved a good calibration (Pearson’s χ2=29.55, p=0.08) and acceptable discrimination with an AUC of 0.721 (95% CI 0.61 to 0.83) with a sensitivity of 74.1% and specificity of 59.4% in the validation dataset.Conclusion We developed and validated an INSPIRE that efficiently differentiates Pakistani pregnant women at high risk of GDM from those at low risk, thus reducing the unnecessary burden of the OGTT test.https://bmjpublichealth.bmj.com/content/2/1/e000920.full |
| spellingShingle | Romaina Iqbal Iqbal Azam Subhash Chandir Rahat Qureshi Ali Jaffar Neelofur Babar Sabahat Naz Samreen Jamal Aisha Syed Wali Development and validation of a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for the screening of high-risk pregnant women for gestational diabetes mellitus in Pakistan BMJ Public Health |
| title | Development and validation of a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for the screening of high-risk pregnant women for gestational diabetes mellitus in Pakistan |
| title_full | Development and validation of a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for the screening of high-risk pregnant women for gestational diabetes mellitus in Pakistan |
| title_fullStr | Development and validation of a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for the screening of high-risk pregnant women for gestational diabetes mellitus in Pakistan |
| title_full_unstemmed | Development and validation of a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for the screening of high-risk pregnant women for gestational diabetes mellitus in Pakistan |
| title_short | Development and validation of a Non-INvaSive Pregnancy RIsk ScoRE (INSPIRE) for the screening of high-risk pregnant women for gestational diabetes mellitus in Pakistan |
| title_sort | development and validation of a non invasive pregnancy risk score inspire for the screening of high risk pregnant women for gestational diabetes mellitus in pakistan |
| url | https://bmjpublichealth.bmj.com/content/2/1/e000920.full |
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