Prediction of Early Feeding Dysfunction in Neonates of Women with Gestational Diabetes Mellitus Using Late-pregnancy Maternal Glycemic Indices and Fetal Gastric Ultrasound Parameters: A Multicenter Prospective Cohort Study.

RATIONALE AND

OBJECTIVES

To develop and validate a prenatal prediction model for early feeding dysfunction in neonates born to women with gestational diabetes mellitus (GDM) using late-pregnancy maternal glycemic indices and fetal gastric ultrasound parameters.

MATERIALS AND

METHODS

This multicenter prospective cohort study enrolled singleton pregnancies complicated by GDM from December 2019 to December 2025. Cases from one center were randomly divided into training and validation cohorts. Cases from three other centers formed the external test cohort. The primary outcome was early feeding dysfunction within 72 h after birth. Candidate predictors included maternal characteristics, late-pregnancy glycemic indices, routine fetal biometry, and fetal gastric ultrasound parameters measured at 32+0 to 36+6 weeks. A multivariable logistic regression model was developed and presented as a nomogram. Model performance was assessed by discrimination, calibration, and clinical utility in the training, validation, and test cohorts.

RESULTS

Early feeding dysfunction occurred in 21.3% and 21.4% of neonates in the training and validation cohorts, respectively. The final model included mean 2-hour postprandial glucose in late pregnancy, gastric volume Z score, gastric emptying rate (GER) Z score, and gastric circumference-to-abdominal circumference ratio (GC/AC). The nomogram showed good discrimination, with area under the curve (AUC) values of 0.906, 0.883, and 0.876 in the training, validation, and test cohorts, respectively. Calibration was good in the training and validation cohorts and acceptable in the test cohort. Decision curve and clinical impact curve analyses supported potential clinical utility.

CONCLUSION

This prenatal model integrating late-pregnancy maternal glycemic indices and fetal gastric ultrasound parameters showed good performance for predicting early feeding dysfunction in neonates born to women with GDM.