TY  - JOUR
AU  - Shen, Jiayi
AU  - Chen, Jiebin
AU  - Zheng, Zequan
AU  - Zheng, Jiabin
AU  - Liu, Zherui
AU  - Song, Jian
AU  - Wong, Sum Yi
AU  - Wang, Xiaoling
AU  - Huang, Mengqi
AU  - Fang, Po-Han
AU  - Jiang, Bangsheng
AU  - Tsang, Winghei
AU  - He, Zonglin
AU  - Liu, Taoran
AU  - Akinwunmi, Babatunde
AU  - Wang, Chi Chiu
AU  - Zhang, Casper J P
AU  - Huang, Jian
AU  - Ming, Wai-Kit
PY  - 2020
DA  - 2020/9/15
TI  - An Innovative Artificial Intelligence–Based App for the Diagnosis of Gestational Diabetes Mellitus (GDM-AI): Development Study
JO  - J Med Internet Res
SP  - e21573
VL  - 22
IS  - 9
KW  - AI
KW  - application
KW  - disease diagnosis
KW  - maternal health care
KW  - artificial intelligence
KW  - app
KW  - women
KW  - rural
KW  - innovation
KW  - diabetes
KW  - gestational diabetes
KW  - diagnosis
AB  - Background: Gestational diabetes mellitus (GDM) can cause adverse consequences to both mothers and their newborns. However, pregnant women living in low- and middle-income areas or countries often fail to receive early clinical interventions at local medical facilities due to restricted availability of GDM diagnosis. The outstanding performance of artificial intelligence (AI) in disease diagnosis in previous studies demonstrates its promising applications in GDM diagnosis. Objective: This study aims to investigate the implementation of a well-performing AI algorithm in GDM diagnosis in a setting, which requires fewer medical equipment and staff and to establish an app based on the AI algorithm. This study also explores possible progress if our app is widely used. Methods: An AI model that included 9 algorithms was trained on 12,304 pregnant outpatients with their consent who received a test for GDM in the obstetrics and gynecology department of the First Affiliated Hospital of Jinan University, a local hospital in South China, between November 2010 and October 2017. GDM was diagnosed according to American Diabetes Association (ADA) 2011 diagnostic criteria. Age and fasting blood glucose were chosen as critical parameters.For validation, we performed k-fold cross-validation (k=5) for the internal dataset and an external validation dataset that included 1655 cases from the Prince of Wales Hospital, the affiliated teaching hospital of the Chinese University of Hong Kong, a non-local hospital. Accuracy, sensitivity, and other criteria were calculated for each algorithm. Results: The areas under the receiver operating characteristic curve (AUROC) of external validation dataset for support vector machine (SVM), random forest, AdaBoost, k-nearest neighbors (kNN), naive Bayes (NB), decision tree, logistic regression (LR), eXtreme gradient boosting (XGBoost), and gradient boosting decision tree (GBDT) were 0.780, 0.657, 0.736, 0.669, 0.774, 0.614, 0.769, 0.742, and 0.757, respectively. SVM also retained high performance in other criteria. The specificity for SVM retained 100% in the external validation set with an accuracy of 88.7%. Conclusions: Our prospective and multicenter study is the first clinical study that supports the GDM diagnosis for pregnant women in resource-limited areas, using only fasting blood glucose value, patients’ age, and a smartphone connected to the internet. Our study proved that SVM can achieve accurate diagnosis with less operation cost and higher efficacy. Our study (referred to as GDM-AI study, ie, the study of AI-based diagnosis of GDM) also shows our app has a promising future in improving the quality of maternal health for pregnant women, precision medicine, and long-distance medical care. We recommend future work should expand the dataset scope and replicate the process to validate the performance of the AI algorithms. 
SN  - 1438-8871
UR  - https://www.jmir.org/2020/9/e21573
UR  - https://doi.org/10.2196/21573
UR  - http://www.ncbi.nlm.nih.gov/pubmed/32930674
DO  - 10.2196/21573
ID  - info:doi/10.2196/21573
ER  -