Determining the risk of gestational diabetes using machine learning: A study on first-trimester PAPP-A and β-hCG data

To evaluate the predictive potential of first-trimester biomarkers-pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (β-hCG)-combined with maternal body mass index (BMI), using machine learning (ML) algorithms for the early detection of gestational diabetes mellitus (GDM).

A retrospective cohort study was conducted with 400 pregnant women who underwent first-trimester screening at Ankara Bilkent City Hospital. Demographic, clinical, and biochemical data, including PAPP-A, free β-hCG, and BMI, were collected. ML models, including random forest, gradient boosting, and logistic regression, were employed to predict GDM risk. Data standardization, model training, and performance evaluation were performed using metrics such as accuracy, F1 score, and receiver operating characteristics area under the curve (ROC-AUC).

The combination of PAPP-A, free β-hCG, and BMI significantly enhanced GDM prediction accuracy across all ML models. Gradient boosting achieved the highest performance with an ROC-AUC of 0.715 and an accuracy of 71.3%, demonstrating the robust predictive value of these variables. PAPP-A alone showed limited predictive capacity (ROC-AUC: 0.632), but its integration with BMI improved model performance substantially. Cut-off analyses identified key thresholds for PAPP-A (<1.02) and BMI (>26.12) for effective risk stratification.

This study underscores the potential of integrating first-trimester biomarkers with ML algorithms for early GDM prediction. By using routinely collected clinical data, this approach offers a cost-effective and scalable solution for improving maternal and neonatal health outcomes. Future research should validate these findings in diverse populations and explore the incorporation of additional biomarkers to further refine predictive models.