Establishment of an accurate prediction system for gestational diabetes mellitus based on the characteristics of metabolic kinetics in early pregnancy: a prospective two-center cohort study in population according to IOM criteria

To develop an accurate prediction system for gestational diabetes mellitus (GDM) in women adhering to Institute of Medicine (IOM) weight gain criteria by analyzing early-pregnancy metabolic kinetics and identifying independent risk factors. A prospective two-center cohort study enrolled 1,031 pregnant women meeting IOM guidelines. Clinical, anthropometric, and metabolic parameters (pre-pregnancy BMI, lipid profiles, inflammatory markers) were collected at 6–12 weeks of gestation. Machine learning models were trained on seven core variables identified via logistic regression, with performance evaluated by AUC, sensitivity, and specificity. The GDM group (n = 279) exhibited significantly higher pre-pregnancy weight, BMI, triglycerides (1.21 vs. 0.96 mmol/L, p < 0.001), and inflammatory markers. Multivariate analysis identified parity ≥ 2 (OR = 4.37), family diabetes history (OR = 1.64), third-trimester weight (OR = 1.13), and triglycerides (OR = 1.49) as independent predictors. A neural network model achieved the highest AUC (0.732) with 65.1% sensitivity and 68.9% specificity, outperforming logistic regression and other algorithms. Dynamic weight trajectories and lipid dysregulation were critical risk drivers, even in IOM-compliant women. In pregnant women adhering to IOM weight gain standards, ​early-pregnancy metabolic dysfunction​and specific weight trajectories ​persist as pivotal GDM predictors. Our neural network model integrating seven core variables—including triglyceride levels, dynamic weight patterns (6–10 weeks and 24–28 weeks), and clinical risk factors—achieved superior prediction accuracy compared to conventional weight-centric approaches. This system enables early risk stratification and personalized interventions during the first trimester, addressing a critical gap in prenatal care for guideline-compliant populations at residual GDM risk.