Development and validation of a new antenatal warning score system (DRRiP) for neonatal complications of gestational diabetes

Objective To evaluate the DRRiP (Diabetes Related Risk in Pregnancy) score warning system as a tool for predicting neonatal morbidity in gestational diabetes. Methods A retrospective observational cohort study. By applying nine parameters from an antenatal trichotomy of glycemic, ultrasound, and clinical characteristics, DRRiP scores were calculated and assigned to each patient using a checklist tool. Logistic regression models were used to evaluate the association between DRRiP score and adverse fetal outcomes, after adjusting for maternal age and body mass index (calculated as weight in kilograms divided by the square of height in meters). Results In all, 627 women were studied. DRRiP score was an excellent predictor of macrosomia and shoulder dystocia (both areas under the receiver operating characteristics curves [AUROC] = 0.86), and a modest predictor of preterm delivery, hyperbilirubinemia, neonatal intensive care unit admission and a composite of either of the studied events (AUROC range 0.63–0.69). For the composite outcome, the sensitivity of an amber trigger score of 1 was 68.7% (95% confidence interval [CI] 62.27%–74.63%) and specificity was 48.87% (95% CI 43.85%–53.9%). Specificity at a red trigger score of 3 (89.7%) and a graded increase in post-test probability (90.7% risk at a score of 5) were highly encouraging. Conclusion DRRiP score offers reasonable discriminative performance that could be clinically useful for meaningful risk stratification when making delivery plans.