Predictive Performance of Artificial Intelligence Algorithms for Gestational Diabetes Mellitus in Pregnant Women:...

Gestational diabetes mellitus (GDM) is a common complication during pregnancy, with its incidence increasing year by year. It poses numerous adverse health effects on both mothers and newborns. Accurate prediction of GDM can significantly improve patient prognosis. In recent years, artificial intelligence (AI) algorithms have been increasingly used in the construction of GDM prediction models. However, there is still no consensus on the most effective algorithm or model.

This study aimed to evaluate and compare the performance of existing GDM prediction models constructed using AI algorithms and propose strategies for enhancing model generalizability and predictive accuracy, thereby providing evidence-based insights for the development of more accurate and effective GDM prediction models.

A comprehensive search was conducted across PubMed, Web of Science, Cochrane Library, EMBASE, Scopus, and OVID, covering publications from the inception of databases to June 1, 2025, to include studies that developed or validated GDM prediction models based on AI algorithms. Study selection, data extraction, and risk of bias assessment using the Prediction Model Risk of Bias Assessment Tool were performed independently by 2 reviewers. A bivariate mixed-effects model was used to summarize sensitivity and specificity and to generate a summary receiver operating characteristic (SROC) curve, calculating area under the curve (AUC). The Hartung-Knapp-Sidik-Jonkman method was further used to adjust for the pooled sensitivity and specificity. Between-study standard deviation (τ) and variance (τ²) were extracted from the bivariate model to quantify absolute heterogeneity. The Deek test was used to evaluate small-study effects among included studies. Additionally, subgroup analysis and meta-regression were conducted to compare the performance differences among algorithms and to explore sources of heterogeneity.

Fourteen studies reported on the predictive value for AI algorithms for GDM. After adjustment with the Hartung-Knapp-Sidik-Jonkman method, the pooled sensitivity and specificity were 0.78 (95% CI 0.69-0.86; τ=0.15, τ2=0.02; PI 0.47-1.09) and 0.85 (95% CI 0.78-0.92; τ=0.11, τ2=0.01; PI 0.59-1.11), respectively. The SROC curve showed that the AUC for predicting GDM using AI algorithms was 0.94 (95% CI 0.92-0.96), indicating a strong predictive capability. Deek test (P=.03) and the funnel plot both showed clear asymmetry, suggesting the presence of small-study effects. Subgroup analysis showed that the random forest algorithm exhibited the highest sensitivity (0.83, 95% CI 0.74-0.93), while the extreme gradient boosting algorithm exhibited the highest specificity (0.82, 95% CI 0.77-0.87). Meta-regression further revealed an evaluation in predictive accuracy in prospective study designs (regression coefficient=2.289, P=.001).

Unlike previous narrative reviews, this systematic review innovatively provided a comparative and quantitative synthesis of AI algorithms for GDM prediction. This established an evidence-based framework to guide model selection and identified a critical evidence gap. The key implication for real-world application was the demonstrated necessity of local validation before clinical adoption. Therefore, future work should focus on large-scale, prospective validation studies to develop clinically applicable tools.