The use of machine learning to predict pharmacological therapy in gestational diabetes: a scoping review

Aims: Early identification of pharmacological therapy for gestational diabetes mellitus (GDM), a common pregnancy complication, through machine learning could allow for better therapeutic strategies and improved treatment efficiency. This scoping review aimed to comprehensively review the machine learning models used to predict the need for pharmacological therapy in GDM.
Methods: Four electronic databases—Embase, Medline, IEEE Xplore and Webof Science—were searched for publications between 1 July 2007 and 31 August 2024. Studies predicting pharmacological therapy for GDM using machine learning were included. The Joanna Briggs Institute and PRISMA-ScR checklist was followed, and the Prediction model Risk Of Bias ASsessment Tool (PROBAST)was used to assess quality.
Results: Included were 17 studies presenting 44 models, 61.4% (27/44) predicted any pharmacological therapy use and 38.6% (17/44) predicted insulin use alone. All were binary classifiers, and logistic regression was typically used. The overall area under the receiver operating curve had a median of 0.75. Common clinical variables were found to be predictors, such as history of GDM, gestational week at GDM diagnosis, pregestational body mass index, maternal age, HbA1c, fasting and 1 h glucose from 75 g oral glucose tolerance test. Though 65.9% of models were validated, there was a lack of external validation. There was no evidence of clinical application of the models.
Conclusion: Logistic regression with common clinical variables was often used to predict pharmacological therapy for GDM. Few models were externally vali-dated or clinically applicable.