Combined Predictive Value of Clinical, Ultrasonographic, and Inflammation-Related Indicators for the Risk of Cesarean Delivery Among Women With Gestational Diabetes Mellitus

Corresponding author: YIN xuai, yxachaohu@126.com

DOI: 10.12201/bmr.202611.00012

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  Abstract: Objective To investigate factors associated with cesarean delivery in women with gestational diabetes mellitus (GDM) and evaluate the combined the predictive value of clinical, ultrasonographic, and inflammation-related indicators for the risk of cesarean delivery. Methods This was a single-center retrospective cohort study. A total of 673 women with GDM who delivered at the Fourth Affiliated Hospital of Anhui Medical University between January 2021 and December 2024 were retrospectively analyzed. According to the mode of delivery, they were divided into the cesarean delivery group (n=349) and the vaginal delivery group (n=324). General clinical characteristics, ultrasonographic parameters, and peripheral blood inflammation-related indicators were compared between the two groups. Binary logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed to evaluate the predictive value of the associated indicators and their combination for cesarean delivery. Internal validation was performed using bootstrap resamples to assess optimism-corrected discrimination and calibration. Results Binary logistic regression analysis showed that maternal age, abdominal circumference, maximum vertical pocket of amniotic fluid, and platelet-to-lymphocyte ratio (PLR) were independent factors associated with cesarean delivery in women with GDM (P<0.05). The combination of these four indicators predicted cesarean delivery with an area under the ROC curve (AUC) of 0.751, a sensitivity of 66.5%, and a specificity of 71.3%. After bootstrap internal validation, the optimism-corrected AUC was 0.736, with a calibration intercept of 0.003 and a calibration slope of 0.927. Conclusion Increased maternal age, abdominal circumference, maximum vertical pocket of amniotic fluid, and PLR were independently associated with cesarean delivery in women with GDM. These four indicators, when combined, showed potential value for predicting the risk of cesarean delivery in this population.

  Key words: Gestational diabetes mellitus; Cesarean delivery; Platelet-to-lymphocyte ratio; Maximum vertical pocket of amniotic fluid

  Submit time: 7 November 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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