Article(id=1322929485884043705, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.15.001, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1761321600000, receivedDateStr=2025-10-25, revisedDate=1777737600000, revisedDateStr=2026-05-03, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340568275, onlineDateStr=2026-10-30, pubDate=1786291200000, pubDateStr=2026-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340568275, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340568275, creator=13701087609, updateTime=1793340568275, updator=13701087609, issue=Issue{id=1322929431592972373, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='15', pageStart='2577', pageEnd='2768', issueExtLink='null', onlineDate='null', pubDate='1786291200000', pubDateStr='2026-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793340555332, creator='13701087609', updateTime=1793343107287, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940135335145743, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940135335145744, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929431592972373, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2577, endPage=2587, ext={EN=ArticleExt(id=1322929486186033594, articleId=1322929485884043705, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Construction and validation of a machine learning-based prediction model for the risk of excessive gestational weight gain, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To construct and validate machine learning-based prediction models for the risk of excessive gestational weight gain(EGWG),and to compare the predictive performance of different models, and select the optimal one.

Methods

Using a convenience sampling method,a total of 623 puerpera who delivered at term and received prenatal check-ups at a tertiary grade A hospital in Beijing from December 2024 to June 2025 were selected as the study subjects.Univariate and multivariate Logistic regression were used to screen predictive factors.Prediction models were constructed by using six machine learning algorithms:Logistic regression,support vector machine,gradient boosting machine,neural network,extreme gradient boosting,and categorical boosting.Model performance was evaluated by using metrics,such as the area under the receiver operating characteristic curve(AUC),F1 score,accuracy,sensitivity,specificity,precision,and Brier Score to determine the optimal model,and a web calculator was developed.The SHapley additive explanations(SHAP) method was employed to interpret the contribution of each variable to the outcome in the best model.

Results

Among 623 puerpera,198 (31.8%) cases experienced excessive gestational weight gain. Multivariate analysis results showed that pre-pregnancy body mass index,sedentary time during pregnancy,gestational diabetes mellitus,advanced maternal age,depressive symptoms during pregnancy,insufficient physical activity during pregnancy,and primiparity were risk factors for excessive gestational weight gain.Among the six machine learning models,the gradient boosting machine model demonstrated the best predictive performance(training set: AUC=0.836,F1=0.669;test set:AUC=0.756,F1=0.609).Calculation of SHAP values for the gradient boosting machine model revealed that pre-pregnancy body mass index,sedentary time during pregnancy,and gestational diabetes mellitus were the three key feature variables for predicting excessive gestational weight gain.

Conclusions

This study constructed a machine learning algorithm-based risk prediction model and web calculator for excessive gestational weight gain,providing an effective tool for early clinical identification and prevention.This contributes to the implementation of targeted clinical interventions and improves the effectiveness of gestational weight management.

, authors=Dandan LYU1, 2, Ning LIU2, Xiu ZHU2, Shuangshuang BAI1, Junying HAO1, Sen LI1, authorsList=Dandan LYU, Ning LIU, Xiu ZHU, Shuangshuang BAI, Junying HAO, Sen LI, authorCompany=null, correspAuthors=Sen LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322929489566642633, articleId=1322929485884043705, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=基于机器学习的孕期体重过度增长风险预测模型的构建与验证, columnId=1220689484681761433, journalTitle=护理研究, columnName=科研论著, runingTitle=null, highlight=null, articleAbstract=
目的

基于机器学习构建并验证孕期体重过度增长(EGWG)风险预测模型,比较不同模型预测性能并选择最优模型。

方法

采用便利抽样法,于2024年12月—2025年6月选取在北京市某三级甲等医院产检的623名足月孕妇为研究对象。通过单因素和多因素逻辑回归筛选预测因子,运用逻辑回归、支持向量机、梯度提升机、神经网络、极限梯度提升树以及类别特征梯度提升6种机器学习算法构建预测模型。利用受试者工作特征(ROC)曲线下面积(AUC)、F1分数、准确度、灵敏度、特异度、精确度以及Brier Score指标评估模型性能,以确定最优模型,并开发网页计算器。基于SHAP加性解释(SHapley additive explanations,SHAP)方法解释最佳模型中各变量对发生结局影响的贡献度。

结果

623名产妇中,198人(31.8%)发生孕期体重过度增长。多因素Logistic回归分析结果显示,孕前体质指数、孕期每日静坐时长、妊娠期糖尿病、高龄产妇、孕期抑郁情绪、孕期体力活动不足、初产妇是孕期体重过度增长的危险因素。在6种机器学习模型中,梯度提升机模型预测性能最优(训练集:AUC为0.836,F1为0.669;测试集:AUC为0.756,F1为0.609)。计算梯度提升机模型的SHAP值发现,孕前体质指数、孕期每日静坐时长、妊娠期糖尿病是预测孕期体重过度增长的3个关键特征变量。

结论

本研究构建了基于机器学习算法的孕期体重过度增长风险预测模型及网页计算器,为临床早期识别和预防孕期体重过度增长提供了有效工具,有助于临床开展针对性干预措施,改善孕期体重管理效果。

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吕丹丹,护师,硕士研究生在读

, correspAuthorsNote=
李森,E-mail:
LI Sen, E-mail:
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model of acute kidney injury in critically ill patients with acute pancreatitis:a machine learning approach using the MIMIC-Ⅳ database, refAbstract=null), Reference(id=1322929500559913521, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, doi=null, pmid=null, pmcid=null, year=2019, volume=110, issue=null, pageStart=12, pageEnd=22, url=null, language=null, rfNumber=30, rfOrder=29, authorNames=Christodoulou E, Ma J, Collins G S, journalName=Journal of Clinical Epidemiology, refType=null, unstructuredReference=Christodoulou E,Ma J,Collins G S,et al.A systematic review shows no performance benefit of machine learning over Logistic regression for clinical prediction models[J].Journal of Clinical Epidemiology,2019,110:12-22., articleTitle=A systematic review shows no performance benefit of machine learning over Logistic regression for clinical prediction models, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322929489826689482, 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language=CN, label=图1, caption=训练集产妇孕期体重过度增长预测模型ROC曲线, figureFileSmall=Ay8e3V/ErdzhxW9bjfvW/g==, figureFileBig=ugds9zmAXFP37EItAHKnwg==, tableContent=null), ArticleFig(id=1322929494553670142, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=EN, label=Figure 2, caption=DCA Curve of the excessive gestational weight gain prediction model for the training set, figureFileSmall=Qem3hUHioL5TeaJS9BHPLA==, figureFileBig=40CxRbmfbXUpwPdUR5sI0A==, tableContent=null), ArticleFig(id=1322929494662722047, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=CN, label=图2, caption=训练集产妇孕期体重过度增长预测模型DCA曲线, figureFileSmall=Qem3hUHioL5TeaJS9BHPLA==, figureFileBig=40CxRbmfbXUpwPdUR5sI0A==, tableContent=null), ArticleFig(id=1322929494746608128, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=EN, label=Figure 3, caption=Calibration curve of the excessive 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set, figureFileSmall=dJjf2TAAnCIQ5JJzHCE3MA==, figureFileBig=qexJUtDzXjLtpL6ySGlS9w==, tableContent=null), ArticleFig(id=1322929495329616391, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=CN, label=图6, caption=测试集产妇孕期体重过度增长预测模型校准曲线, figureFileSmall=dJjf2TAAnCIQ5JJzHCE3MA==, figureFileBig=qexJUtDzXjLtpL6ySGlS9w==, tableContent=null), ArticleFig(id=1322929495405113864, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=EN, label=Figure 7, caption=Ranking of feature importance in the GBM prediction model for excessive gestational weight gain in puerpera, figureFileSmall=EeeoPgM3W4cjrU4dqBpOpQ==, figureFileBig=Gth8iDpVRFR23moejDuiYA==, tableContent=null), ArticleFig(id=1322929495484805641, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=CN, label=图7, caption=产妇孕期体重过度增长GBM预测模型的特征变量重要性排序, figureFileSmall=EeeoPgM3W4cjrU4dqBpOpQ==, figureFileBig=Gth8iDpVRFR23moejDuiYA==, tableContent=null), ArticleFig(id=1322929495560303114, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=EN, label=Table 1, caption=

Clinical data of puerpera in the training set

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类非孕期体重过度增长(n=298)孕期体重过度增长(n=139)
人数百分比(%)人数百分比(%)
年龄<35岁17558.75640.3
≥35岁12341.38359.7
受教育水平专科及以下3411.42820.1
本科13344.65640.3
硕士研究生及以上13144.05539.6
婚姻状况未婚82.753.6
已婚29097.313496.4
家庭年收入<20万元237.71913.7
20万~30万元8729.24028.8
>30万元18863.18057.6
居住环境城市28194.313194.2
乡镇175.785.8
受孕方式自然受孕27190.912791.4
辅助生殖技术279.1128.6
产次初产妇23980.212589.9
经产妇5919.81410.1
妊娠期糖尿病无23679.28158.3
有6220.85841.7
妊娠期高血压无27291.311884.9
有268.72115.1
甲状腺功能亢进无29398.313798.6
有51.721.4
甲状腺功能减退无28094.012086.3
有186.01913.7
孕期抑郁情绪无28094.010777.0
有186.03223.0
规律参加产妇课堂否14247.77956.8
是15652.36043.2
孕期体力活动水平充足23077.28359.7
不充足6822.85640.3
), ArticleFig(id=1322929495631606283, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=CN, label=表1, caption=

训练集产妇的临床资料

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类非孕期体重过度增长(n=298)孕期体重过度增长(n=139)
人数百分比(%)人数百分比(%)
年龄<35岁17558.75640.3
≥35岁12341.38359.7
受教育水平专科及以下3411.42820.1
本科13344.65640.3
硕士研究生及以上13144.05539.6
婚姻状况未婚82.753.6
已婚29097.313496.4
家庭年收入<20万元237.71913.7
20万~30万元8729.24028.8
>30万元18863.18057.6
居住环境城市28194.313194.2
乡镇175.785.8
受孕方式自然受孕27190.912791.4
辅助生殖技术279.1128.6
产次初产妇23980.212589.9
经产妇5919.81410.1
妊娠期糖尿病无23679.28158.3
有6220.85841.7
妊娠期高血压无27291.311884.9
有268.72115.1
甲状腺功能亢进无29398.313798.6
有51.721.4
甲状腺功能减退无28094.012086.3
有186.01913.7
孕期抑郁情绪无28094.010777.0
有186.03223.0
规律参加产妇课堂否14247.77956.8
是15652.36043.2
孕期体力活动水平充足23077.28359.7
不充足6822.85640.3
), ArticleFig(id=1322929495711298060, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=EN, label=Table 2, caption=

Results of univariate logistic regression analysis of factors influencing excessive gestational weight gain in puerpera

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类回归系数标准误OR值95%CIP
年龄<35岁1.00
≥35岁0.7470.2032.11[1.40,3.18]<0.001
受教育水平专科及以下1.00
本科-0.6730.3060.51[0.28,0.92]0.026
硕士研究生及以上-0.6730.3060.51[0.28,0.92]0.025
婚姻状况未婚1.00
已婚0.2930.5421.34[0.42,4.27]0.618
家庭年收入<20万元1.00
20万~30万元-0.5790.3830.56[0.27,1.14]0.108
>30万元-0.6540.3650.52[0.27,1.00]0.049
居住环境城市1.00
乡镇0.0100.4471.01[0.42,2.40]0.983
受孕方式自然受孕1.00
辅助生殖技术-0.0510.3510.95[0.47,1.93]0.884
产次初产妇1.00
经产妇-0.7980.3160.45[0.24,0.84]0.013
妊娠期糖尿病无1.00
有1.0050.2232.73[1.76,4.22]<0.001
妊娠期高血压无1.00
有0.6210.3121.86[1.01,3.44]0.047
甲状腺功能亢进无1.00
有-0.1510.7070.86[0.16,4.46]0.853
甲状腺功能减退无1.00
有0.9000.3432.46[1.25,4.86]0.009
孕期抑郁情绪无1.00
有1.5370.3104.65[2.51,8.64]<0.001
规律参加产妇课堂否1.00
是-0.3710.2030.69[0.46,1.04]0.074
孕期体力活动水平充足1.00
不充足0.8240.2202.28[1.48,3.52]<0.001
孕前体质指数0.1570.0321.17[1.09,1.25]<0.001
分娩前血清白蛋白-0.0620.0410.94[0.88,1.02]0.126
分娩前血红蛋白-0.0100.0070.99[0.97,1.01]0.166
每日静坐时长0.2150.0721.24[1.08,1.42]0.002
), ArticleFig(id=1322929495845515789, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=CN, label=表2, caption=

产妇发生孕期体重过度增长影响因素的单因素Logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类回归系数标准误OR值95%CIP
年龄<35岁1.00
≥35岁0.7470.2032.11[1.40,3.18]<0.001
受教育水平专科及以下1.00
本科-0.6730.3060.51[0.28,0.92]0.026
硕士研究生及以上-0.6730.3060.51[0.28,0.92]0.025
婚姻状况未婚1.00
已婚0.2930.5421.34[0.42,4.27]0.618
家庭年收入<20万元1.00
20万~30万元-0.5790.3830.56[0.27,1.14]0.108
>30万元-0.6540.3650.52[0.27,1.00]0.049
居住环境城市1.00
乡镇0.0100.4471.01[0.42,2.40]0.983
受孕方式自然受孕1.00
辅助生殖技术-0.0510.3510.95[0.47,1.93]0.884
产次初产妇1.00
经产妇-0.7980.3160.45[0.24,0.84]0.013
妊娠期糖尿病无1.00
有1.0050.2232.73[1.76,4.22]<0.001
妊娠期高血压无1.00
有0.6210.3121.86[1.01,3.44]0.047
甲状腺功能亢进无1.00
有-0.1510.7070.86[0.16,4.46]0.853
甲状腺功能减退无1.00
有0.9000.3432.46[1.25,4.86]0.009
孕期抑郁情绪无1.00
有1.5370.3104.65[2.51,8.64]<0.001
规律参加产妇课堂否1.00
是-0.3710.2030.69[0.46,1.04]0.074
孕期体力活动水平充足1.00
不充足0.8240.2202.28[1.48,3.52]<0.001
孕前体质指数0.1570.0321.17[1.09,1.25]<0.001
分娩前血清白蛋白-0.0620.0410.94[0.88,1.02]0.126
分娩前血红蛋白-0.0100.0070.99[0.97,1.01]0.166
每日静坐时长0.2150.0721.24[1.08,1.42]0.002
), ArticleFig(id=1322929495929401870, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=EN, label=Table 3, caption=

Results of multivariate Logistic regression analysis of factors influencing excessive gestational weight gain in puerperae

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类回归系数标准误OR值95%CIP
年龄<35岁1.00
≥35岁0.6530.2171.92[1.21,3.06]0.006
受教育水平专科及以下1.00
本科-0.2740.3760.76[0.37,1.53]0.440
硕士研究生及以上-0.1980.3940.82[0.38,1.79]0.622
家庭年收入<20万元1.00
20万~30万元-0.2230.4320.80[0.34,1.85]0.598
>30万元-0.2480.4260.78[0.34,1.83]0.573
产次初产妇1.00
经产妇-0.9420.3570.39[0.20,0.77]0.007
妊娠期糖尿病无1.00
有0.7030.2512.02[1.23,3.33]0.006
妊娠期高血压无1.00
有-0.2610.3890.77[0.36,1.67]0.514
甲状腺功能减退无1.00
有0.6250.3951.88[0.87,4.08]0.108
孕期抑郁情绪无1.00
有1.3240.3513.76[1.87,7.59]<0.001
孕期体力活动水平充足1.00
不充足0.5820.2461.79[1.10,2.92]0.019
孕前体质指数0.1040.0391.11[1.03,1.19]0.008
每日静坐时长0.1660.0771.18[1.02,1.37]0.027
), ArticleFig(id=1322929496025870863, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=CN, label=表3, caption=

产妇发生孕期体重过度增长影响因素的多因素Logistic回归分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类回归系数标准误OR值95%CIP
年龄<35岁1.00
≥35岁0.6530.2171.92[1.21,3.06]0.006
受教育水平专科及以下1.00
本科-0.2740.3760.76[0.37,1.53]0.440
硕士研究生及以上-0.1980.3940.82[0.38,1.79]0.622
家庭年收入<20万元1.00
20万~30万元-0.2230.4320.80[0.34,1.85]0.598
>30万元-0.2480.4260.78[0.34,1.83]0.573
产次初产妇1.00
经产妇-0.9420.3570.39[0.20,0.77]0.007
妊娠期糖尿病无1.00
有0.7030.2512.02[1.23,3.33]0.006
妊娠期高血压无1.00
有-0.2610.3890.77[0.36,1.67]0.514
甲状腺功能减退无1.00
有0.6250.3951.88[0.87,4.08]0.108
孕期抑郁情绪无1.00
有1.3240.3513.76[1.87,7.59]<0.001
孕期体力活动水平充足1.00
不充足0.5820.2461.79[1.10,2.92]0.019
孕前体质指数0.1040.0391.11[1.03,1.19]0.008
每日静坐时长0.1660.0771.18[1.02,1.37]0.027
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Predictive performance of the excessive gestational weight gain prediction model and results of Hosmer-Lemeshow test for the training set

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模型AUC准确度灵敏度特异度精确度F1分数Brier ScoreHosmer-Lemeshow检验(P)
LR0.7570.7050.6830.7150.5280.5960.1770.973
SVM0.7450.7440.5540.8320.6060.5790.1910.303
GBM0.8360.7780.7050.8120.6360.6690.1470.369
NN0.7540.7000.6980.7010.5220.5970.1790.506
XGBoost0.7740.6890.7910.6410.5070.6180.2490.109
CatBoost0.7570.6520.7770.5940.4720.5870.2840.322
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训练集产妇孕期体重过度增长预测模型预测性能及Hosmer-Lemeshow检验结果

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模型AUC准确度灵敏度特异度精确度F1分数Brier ScoreHosmer-Lemeshow检验(P)
LR0.7570.7050.6830.7150.5280.5960.1770.973
SVM0.7450.7440.5540.8320.6060.5790.1910.303
GBM0.8360.7780.7050.8120.6360.6690.1470.369
NN0.7540.7000.6980.7010.5220.5970.1790.506
XGBoost0.7740.6890.7910.6410.5070.6180.2490.109
CatBoost0.7570.6520.7770.5940.4720.5870.2840.322
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Predictive performance of the excessive gestational weight gain prediction model and results of the Hosmer-Lemeshow test for the testing set

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模型AUC准确度灵敏度特异度精确度F1分数Brier ScoreHosmer-Lemeshow检验(P)
LR0.7700.7630.610.8350.6320.6210.1780.219
SVM0.7700.780.5760.8740.680.6240.1980.214
GBM0.7560.7310.6610.7640.5650.6090.1840.716
NN0.7320.6940.7460.6690.5120.6070.1870.532
XGBoost0.7470.7310.7120.740.560.6270.2490.081
CatBoost0.7660.7630.5760.850.6420.6070.2840.110
), ArticleFig(id=1322929497942667795, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929485884043705, language=CN, label=表5, caption=

测试集产妇孕期体重过度增长预测模型预测性能及Hosmer-Lemeshow检验结果

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模型AUC准确度灵敏度特异度精确度F1分数Brier ScoreHosmer-Lemeshow检验(P)
LR0.7700.7630.610.8350.6320.6210.1780.219
SVM0.7700.780.5760.8740.680.6240.1980.214
GBM0.7560.7310.6610.7640.5650.6090.1840.716
NN0.7320.6940.7460.6690.5120.6070.1870.532
XGBoost0.7470.7310.7120.740.560.6270.2490.081
CatBoost0.7660.7630.5760.850.6420.6070.2840.110
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基于机器学习的孕期体重过度增长风险预测模型的构建与验证
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吕丹丹 1, 2 , 刘宁 2 , 朱秀 2 , 白爽爽 1 , 郝君颖 1 , 李森 1, *, *
护理研究 | 科研论著 2026,40(15): 2577-2587
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护理研究 |科研论著 2026 , 40 (15) : 2577 -2587
基于机器学习的孕期体重过度增长风险预测模型的构建与验证
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吕丹丹1, 2, 刘宁2, 朱秀2, 白爽爽1, 郝君颖1, 李森1, *, *
作者信息
  • 1北京大学人民医院,北京 100044
  • 2北京大学护理学院
通讯作者:
李森,E-mail:
LI Sen, E-mail:
作者简介:

吕丹丹,护师,硕士研究生在读

Construction and validation of a machine learning-based prediction model for the risk of excessive gestational weight gain
Dandan LYU1, 2, Ning LIU2, Xiu ZHU2, Shuangshuang BAI1, Junying HAO1, Sen LI1
Affiliations
  • 1Peking University People's Hospital, Beijing 100044 China
  • 2School of Nursing, Peking University
出版时间: 2026-08-10 doi: 10.12102/j.issn.1009-6493.2026.15.001
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目的

基于机器学习构建并验证孕期体重过度增长(EGWG)风险预测模型,比较不同模型预测性能并选择最优模型。

方法

采用便利抽样法,于2024年12月—2025年6月选取在北京市某三级甲等医院产检的623名足月孕妇为研究对象。通过单因素和多因素逻辑回归筛选预测因子,运用逻辑回归、支持向量机、梯度提升机、神经网络、极限梯度提升树以及类别特征梯度提升6种机器学习算法构建预测模型。利用受试者工作特征(ROC)曲线下面积(AUC)、F1分数、准确度、灵敏度、特异度、精确度以及Brier Score指标评估模型性能,以确定最优模型,并开发网页计算器。基于SHAP加性解释(SHapley additive explanations,SHAP)方法解释最佳模型中各变量对发生结局影响的贡献度。

结果

623名产妇中,198人(31.8%)发生孕期体重过度增长。多因素Logistic回归分析结果显示,孕前体质指数、孕期每日静坐时长、妊娠期糖尿病、高龄产妇、孕期抑郁情绪、孕期体力活动不足、初产妇是孕期体重过度增长的危险因素。在6种机器学习模型中,梯度提升机模型预测性能最优(训练集:AUC为0.836,F1为0.669;测试集:AUC为0.756,F1为0.609)。计算梯度提升机模型的SHAP值发现,孕前体质指数、孕期每日静坐时长、妊娠期糖尿病是预测孕期体重过度增长的3个关键特征变量。

结论

本研究构建了基于机器学习算法的孕期体重过度增长风险预测模型及网页计算器,为临床早期识别和预防孕期体重过度增长提供了有效工具,有助于临床开展针对性干预措施,改善孕期体重管理效果。

妊娠期体重增长  /  孕期体重过度增长  /  产妇  /  机器学习  /  预测模型  /  影响因素
Objective

To construct and validate machine learning-based prediction models for the risk of excessive gestational weight gain(EGWG),and to compare the predictive performance of different models, and select the optimal one.

Methods

Using a convenience sampling method,a total of 623 puerpera who delivered at term and received prenatal check-ups at a tertiary grade A hospital in Beijing from December 2024 to June 2025 were selected as the study subjects.Univariate and multivariate Logistic regression were used to screen predictive factors.Prediction models were constructed by using six machine learning algorithms:Logistic regression,support vector machine,gradient boosting machine,neural network,extreme gradient boosting,and categorical boosting.Model performance was evaluated by using metrics,such as the area under the receiver operating characteristic curve(AUC),F1 score,accuracy,sensitivity,specificity,precision,and Brier Score to determine the optimal model,and a web calculator was developed.The SHapley additive explanations(SHAP) method was employed to interpret the contribution of each variable to the outcome in the best model.

Results

Among 623 puerpera,198 (31.8%) cases experienced excessive gestational weight gain. Multivariate analysis results showed that pre-pregnancy body mass index,sedentary time during pregnancy,gestational diabetes mellitus,advanced maternal age,depressive symptoms during pregnancy,insufficient physical activity during pregnancy,and primiparity were risk factors for excessive gestational weight gain.Among the six machine learning models,the gradient boosting machine model demonstrated the best predictive performance(training set: AUC=0.836,F1=0.669;test set:AUC=0.756,F1=0.609).Calculation of SHAP values for the gradient boosting machine model revealed that pre-pregnancy body mass index,sedentary time during pregnancy,and gestational diabetes mellitus were the three key feature variables for predicting excessive gestational weight gain.

Conclusions

This study constructed a machine learning algorithm-based risk prediction model and web calculator for excessive gestational weight gain,providing an effective tool for early clinical identification and prevention.This contributes to the implementation of targeted clinical interventions and improves the effectiveness of gestational weight management.

gestational weight gain,GWG  /  excessive gestational weight gain,EGWG  /  puerpera  /  machine learning  /  prediction model  /  influencing factors
吕丹丹, 刘宁, 朱秀, 白爽爽, 郝君颖, 李森. 基于机器学习的孕期体重过度增长风险预测模型的构建与验证. 护理研究, 2026 , 40 (15) : 2577 -2587 . DOI: 10.12102/j.issn.1009-6493.2026.15.001
Dandan LYU, Ning LIU, Xiu ZHU, Shuangshuang BAI, Junying HAO, Sen LI. Construction and validation of a machine learning-based prediction model for the risk of excessive gestational weight gain[J]. Chinese Nursing Research, 2026 , 40 (15) : 2577 -2587 . DOI: 10.12102/j.issn.1009-6493.2026.15.001
妊娠期体重增长(gestational weight gain,GWG)通常定义为妊娠期增长的体重,从第1次产前检查时记录的体重开始,到最后1次产前检查时的体重结束[1-2]。美国医学研究所(Institute of Medicine,IOM)[1]和我国国内行业标准[3]均指出,妊娠期体重增加不应超过推荐值,当妊娠期体重增加超过适宜增重值即为孕期体重过度增长(excessive gestational weight gain,EGWG)。孕期体重过度增长正在成为一种世界性流行病[4]。既往研究显示,全球约47%的产妇体重增长超过美国医学研究所提供的体重增长推荐值[5]。美洲、欧洲、大洋洲、亚洲、非洲的孕期体重过度增长发生率分别为49.8%、42.3%、49.0%、38.2%、55.20%[6]。我国孕期体重过度增长发生率为37%[7]。孕期体重过度增长不仅增加了不良围产结局的风险,如妊娠期糖尿病(gestational diabetes mellitus,GDM)、妊娠期高血压(hypertensive disorders of pregnancy,HDP)、剖宫产、巨大儿、早产等,还增加了产妇及子代全生命周期并发症的发生风险,如糖尿病、高血压、肥胖等[8-9]。因此,早期识别孕期体重过度增长的高危人群并采取针对性干预措施至关重要。既往有研究已经构建了孕期体重过度增长风险预测模型[10],但是该模型采用单一的Logistic回归方法,缺乏多种方法综合评估的比较,且在临床应用方面,现有评分工具需要人工计算,未开发网页计算器。近年来,机器学习(machine learning,ML)算法在疾病预测模型的开发中展现出巨大潜力,与传统的逻辑回归方法相比,机器学习作为一种多维数据挖掘方法,以其强大的计算能力和自动数据驱动的特性,能够更准确地进行临床疾病预测[11]。且不同算法各有优劣,需在同一样本中采用多种算法构建预测模型并进行性能比较。因此,本研究旨在构建并验证孕期体重过度增长的6种机器学习预测模型,比较这6种预测模型的性能,科学地探索最佳性能的预测模型,并根据最佳模型开发网页计算器,精准预测孕期体重过度增长发生率,为临床实践提供指导。
采用便利抽样法,于2024年12月—2025年6月,选取北京市某三级甲等医院产检的产妇作为调查对象。纳入标准:1)年龄≥18岁;2)妊娠37~41+6周;3)宫内活胎;4)自愿接受相关问卷的调查和病例资料收集。排除标准:1)双胎及以上妊娠;2)有精神疾病或认知障碍者;3)患有严重贫血、糖尿病、高血压、甲状腺功能异常合并症及心、肝、肾、肺等疾病。根据既往研究文献,我国孕期体重过度增长发生率为37%[7]。依据Riley等[12]临床预测模型样本量计算指南,采用R软件pmsampsize包计算预测模型构建所需样本量,设c统计量可达到0.8,需纳入359人,考虑到20%的样本脱落率,预计最少需要431人,本研究纳入623人。本研究已获得北京大学人民医院医学伦理委员会批准(批件号:2024PHB545-001)。
依据《妊娠期妇女体重增长推荐值标准》[3]的规定,妊娠前体重=妊娠前3个月内的平均体重,妊娠期体重总增长值=分娩前体重-妊娠前体重。根据妊娠前体质指数(body mass index,BMI)确定妊娠期妇女体重适宜增重范围,分为妊娠期体重增长不足、增长适宜、增长过多3种。消瘦(体质指数<18.5 kg/m2)、正常体重(体质指数为18.5~<24.0 kg/m2)、超重(体质指数为24.0~<28.0 kg/m2)、肥胖(体质指数≥28.0 kg/m2)对应适宜增重值分别为11.0~16.0 kg、8.0~14.0 kg、7.0~11.0 kg、5.0~9.0 kg。当孕期体重增长超过上述体重适宜增重值时,判定为孕期体重过度增长。
该调查问卷由研究者基于文献分析自行设计,内容包括年龄、孕前体质指数、受教育水平、家庭年收入、居住环境、孕期增重、妊娠期合并症、孕期体力活动、孕期抑郁情绪、实验室检查结果等情况。
PHQ-9是由Spitzer等[13]基于美国精神疾病诊断与统计手册(DSM-Ⅳ)于1999年制定的抑郁自评工具,反映病人近2周内在抑郁方面的精神心理活动。该问卷由9个条目组成,每个条目答案均由完全不会、好几天、超过1周、几乎每天4个选项构成,分别计0、1、2、3分,总分27分。得分0~4分为无抑郁,≥5分为抑郁。研究证实PHQ-9具有较好的信度和效度[14],且国内已有研究将其应用于妊娠期女性的调查中[15]。
IPAQ-S由国际体力活动测量工作组于2003年制定[16],屈宁宁等[17]于2004年对其进行汉化和信效度检验,用于调查受试者过去7 d高强度体力活动、中等强度体力活动、低强度体力活动(步行)情况及静坐时间。该问卷已在我国妊娠期人群中进行过验证[18]。基于产妇所填报的1周内各项活动的开展频率以及每次活动所持续的时间,计算产妇在体力活动方面的能量消耗状况。具体计算方式为:个体每周从事高/中/低强度体力活动能量消耗=高/中/低强度体力活动对应的代谢当量,即指人体进行各种活动所需的耗氧量(metabolic equivalent,MET)值×每周活动频率(d/w)×每天活动时间(min/d),3种强度体力活动能耗相加即为总体力活动能耗。依据既定的评定标准,可将产妇的体力活动水平划分为高、中、低3个类别。在本研究中,将中等强度及高强度的体力活动归为体力活动充足组;将低强度的体力活动归为体力活动不充足组。久坐行为(sedentary behavior,SB)是指产妇自述在过去7 d清醒状态下,平均每日处于坐着或躺着状态的总时长。其中涵盖了工作期间的静坐时间、在家中的静坐时间以及休闲娱乐时的静坐时间。采用已知群体效度法[19-20]验证问卷的结构效度,结果显示,孕晚期产妇的体力活动水平为(894.18±578.56)MET-min/w,显著低于孕中期产妇[(939.48±607.87)MET-min/w]和孕早期产妇[(937.97±592.14)MET-min/w]的体力活动水平,差异均有统计学意义(P<0.05)。这一结果符合理论预期,表明IPAQ-S问卷具有良好的结构效度,能够有效区分不同孕期产妇的体力活动水平。
采用线下填写问卷的方式进行调查。选择2名调查员协助,由研究者对其进行统一培训。获得产妇知情同意后,采用统一指导语说明问卷的填写方法和注意事项。一般资料部分信息通过查看产妇病历和实验室报告获得。对于问卷填写存在困难的产妇,研究人员采取提问的方式帮助其填写。问卷当场回收并核实,若有缺项、漏项,当场补充,以保证问卷的有效性。问卷回收后,经双人核查,剔除答题时间短于5 min、答案规律或连续选项相同大于条目50%的无效问卷。
由双人采用Epi Data 3.1软件进行数据录入核对。在数据处理阶段,将全部数据按照7∶3的比例划分,随机种子设定为521,得到训练集和测试集。用训练集构建模型,测试集进行模型验证。数据分析与模型构建工作借助R 5.1.0软件完成。首先,利用R 5.1.0软件中相应的软件包和函数分别开展单因素和多因素回归分析,筛选出有统计学意义的影响因素。在模型构建时,在训练集和测试集上采用逻辑回归(Logistic regression,LR)、支持向量机(support vector machine,SVM)、梯度提升机(gradient boosting machine,GBM)、神经网络(neural network,NN)、极限梯度提升树(eXtreme gradient boosting,XGBoost)以及类别特征梯度提升(categorical boosting,CatBoost)6种机器学习方法构建预测模型。选用多个指标进行模型性能评估,包括受试者工作特征(ROC)曲线下面积(area under the curve,AUC)、准确度、灵敏度、特异度、精确度、F1分数以及Brier Score。其中,AUC为0~1,若AUC为0.5~0.7,表明模型的预测性能欠佳;AUC>0.7~0.9,则意味着模型的预测性能处于中等水平;当AUC>0.9时,说明模型的预测性能出色。F1分数为0~1,该值越接近1,代表模型的预测性能越优。本研究综合考量训练集和测试集的AUC和F1分数确定最优模型。采用校准曲线(calibration curve)和Hosmer-Lemeshow检验评估模型预测概率与实际孕期体重过度增长发生率的一致性。此外,为量化评估预测模型在临床决策中的实际效用,运用决策曲线分析(decision curve analysis,DCA)方法,呈现模型的净效益。SHAP加性解释(SHapley additive explanations,SHAP)作为一种基于博弈论的方法,可用于解释机器学习模型的输出结果。SHAP 能够为预测模型中的每个输入特征变量赋予相应的值,即SHAP值,SHAP值的绝对值越大,表明该特征变量在模型中的重要性越大。依据SHAP值构建摘要图,对风险因素的重要性进行排序。最后,根据最优模型开发网页计算器,为更精准预测孕期体重过度增长提供简易工具。
共纳入623名产妇,其中孕期体重过度增长产妇198人(31.8%),非孕期体重过度增长产妇425人(68.2%)。按照7∶3比例,训练集437例的产妇中,孕期体重过度增长产妇139人(31.8%),非孕期体重过度增长产妇298人(68.2%);测试集186例的产妇中,孕期体重过度增长产妇59人(31.7%),非孕期体重过度增长产妇127人(68.3%)。训练集产妇中非孕期体重过度增长产妇的孕前体质指数为(22.1±2.9)kg/m2,分娩前血清白蛋白为(38.0±2.7)g/L,分娩前血红蛋白为(124.5±9.9)g/L,每日静坐时长为(7.5±1.6)h;孕期体重过度增长产妇的孕前体质指数为(23.6±3.5)kg/m2,分娩前血清白蛋白为(37.6±2.8)g/L,分娩前血红蛋白为(123.1±10.2)g/L,每日静坐时长为(8.0±1.4)h,其余资料见表1。
对训练集纳入的指标进行单因素逻辑回归分析,共筛选出11个自变量(年龄、受教育水平、家庭年收入、产次、妊娠期糖尿病、妊娠期高血压、甲状腺功能减退、孕期抑郁情绪、每日静坐时长、孕期体力活动水平、孕前体质指数)(P<0.05),详见表2。
将单因素分析中有统计学意义的影响因素(年龄、受教育水平、家庭年收入、产次、妊娠期糖尿病、妊娠期高血压、甲状腺功能减退、孕期抑郁情绪、每日静坐时长、孕期体力活动水平、孕前体质指数)纳入多因素逻辑回归分析,结果显示,年龄、产次、妊娠期糖尿病、孕期抑郁情绪、每日静坐时长、孕期体力活动水平、孕前体质指数是孕期体重过度增长的独立影响因素(P<0.05),详见表3。
将多因素分析筛选出来的7个预测因子(年龄、产次、妊娠期糖尿病、孕期抑郁情绪、每日静坐时长、孕期体力活动水平、孕前体质指数)作为自变量,分别采用LR、SVM、GBM、NN、XGBoost、CatBoost 6种机器学习方法进行预测模型的构建。训练集产妇孕期体重过度增长预测模型ROC曲线见图1,DCA曲线见图2,校准曲线见图3,预测性能及Hosmer-Lemeshow检验结果见表4。
基于测试集,对6种预测模型进行内部验证,其ROC曲线见图4,DCA曲线见图5,校准曲线见图6,预测性能及Hosmer-Lemeshow检验结果见表5。
综合考虑训练集和测试集模型的AUC和F1分数,结果显示,GBM预测模型预测性能最优。SHAP值可以解释为特征变量的重要性,反映了特征变量对预测结局的影响。本研究中GBM模型的特征变量重要性排序见图7。基于GBM模型开发了网页计算器,网址为:https://weirdo.shinyapps.io/egwg/。
本研究结果显示,北京市623名单胎产妇孕期体重过度增长发生率为31.8%。值得注意的是,本研究中孕期体重过度增长组与非孕期体重过度增长组在训练集和测试集的分布比例基本一致(31.8%,31.7%),表明数据划分合理。与其他研究相比,本研究结果低于龙美岑等[7]对我国的研究结果(37%),且明显低于Goldstein等[5]对全球的研究结果(47%)及美洲、欧洲、大洋洲、亚洲、非洲的研究结果(49.8%、42.3%、49.0%、38.2%、55.20%)[4]。这可能与北京地区的产妇经济收入、受教育水平、生活行为及政府倡导体重管理因素等有关。此外,所选医院作为三级甲等医院,医院定期开设产妇课堂及各种健康教育活动等,并对产妇进行规范化体重管理,从而降低了孕期体重过度增长的发生率。
本研究结果显示,孕前较高的体质指数是孕期体重过度增长的独立危险因素,这一结果与国内外多项研究[4,21-22]结果相一致。孕前超重/肥胖的人群更容易发生孕期体重过度增长[21],这可能是由于此类人群存在高热量饮食和低运动量的不良生活习惯,且在孕期内难以改变此类生活方式。鉴于此,母婴保健者应重点关注此类人群,鼓励其孕前积极减重,转变不良生活方式,在孕期也要严格把控体重增长,确保母婴健康。
本研究结果显示,每日静坐时长增加是孕期体重过度增长的危险因素,这与既往研究[2,23]结果一致。久坐行为会减少非运动性热消耗,导致能量过剩,同时加剧胰岛素抵抗和脂质代谢紊乱,进而促进脂肪堆积,增加孕期体重过度增长的发生风险[2]。
本研究结果显示:体力活动不足与孕期体重过度增长密切相关。Acosla-Manzano等[24]研究也证明,运动有助于优化妊娠期体重增加和体重保持,减轻与体重增加过多有关的表型受损。提示医务人员可以借助移动健康干预方式,为产妇提供规范化、个性化的运动指导,鼓励她们积极参与体育锻炼,减少静坐时间,维持适宜的体重增长。
本研究结果显示,妊娠期糖尿病是孕期体重过度增长的危险因素。妊娠期糖尿病引发的胰岛素抵抗会促进脂肪合成、抑制脂肪分解,导致体重不断攀升[25];同时,高血糖环境还会刺激胎儿分泌激素,进一步加剧产妇的代谢紊乱,推动体重过度增长,形成恶性循环[26]。基于这一发现,未来需重点关注妊娠期糖尿病人群,为其提供结构化的体重管理指导,帮助她们有效控制体重。
本研究结果显示孕期抑郁情绪与孕期体重过度增长相关,这与英国学者Garay等[27]研究结果一致。孕期抑郁情绪不仅会影响产妇的心理健康,还可能对体重管理产生不利影响。因此,建议将女性心理健康问题筛查常规纳入产科服务中,及时发现并干预产妇孕期抑郁情绪,保障产妇的身心健康。
本研究也观察到高龄产妇更容易出现孕期体重过度增长,这与华知奋等[26]研究结果类似。可能是因为随着年龄的增长,基础代谢率逐渐降低,能量消耗降低,即使保持与之前相同的饮食和运动习惯,摄入的热量也更容易转化为脂肪。建议对此类人群,在孕前和孕期通过个性化的营养评估与运动指导,有效地控制产妇体重增长,降低母婴并发症的风险。
本研究结果显示,相对于经产妇,初产妇发生体重过度增长的危险性更大,这与周洁等[28]研究结果一致。初产妇由于缺乏分娩经验,对体重管理方面的认知和意识往往较为薄弱,未能充分认识到孕期体重合理增长的重要性,也难以形成在妊娠期保持合理膳食结构以及坚持规律运动的良好习惯。鉴于此,针对初产妇开展孕期保健指导,并实施具有针对性的健康宣教工作显得尤为关键。
本研究对LR、SVM、GBM、NN、XGBoost、CatBoost 6种机器学习算法在孕期体重过度增长预测中的表现进行了系统评估。结果显示,GBM预测模型展现出最优异的预测性能(训练集:AUC为0.836,F1分数为0.669;测试集:AUC为0.756,F1分数为0.609),这主要得益于其集成学习机制能够有效捕捉变量间的非线性关系和交互作用[29]。LR模型虽然预测性能稍逊(训练集:AUC为0.757,F1分数为0.596;测试集:AUC为0.770,F1分数为0.621),但其优势在于模型结构简单、稳定性好,通过回归系数可以直观解释各因素对孕期体重过度增长风险的影响程度[30],这种量化关系为临床决策提供了明确依据,但在构建模型时该算法易受变量间多重共线性影响,处理复杂决策边界时预测性能欠佳,无法处理复杂非线性关系。因此,本研究中GBM预测模型是预测孕期体重过度增长的最优模型,也进一步表明机器学习算法具备的强大预测优势,可作为临床风险预测的早期预警系统,为识别与预防孕期体重过度增长提供更加全面的依据,帮助产妇进行更好的体重管理。
本研究在方法学和应用价值方面具有显著优势。首先,运用6种机器学习算法,对不同模型在孕期体重过度增长预测中的表现展开系统比较,且根据最优模型开发网页计算器,为该领域研究提供了新颖且全面的方法思路。其次,筛选出孕期体重过度增长预测因子及进行预测因子的重要性排序,便于产妇及医务人员重点地开展干预措施,有效规范产妇孕期的体重管理,提升孕期健康水平。然而,本研究仍存在一定局限性:作为单中心研究,样本均来自同1所三级医院,可能限制模型的普适性;此外,该预测模型的临床应用效果尚需通过前瞻性研究进一步验证。未来可扩大样本量,收集多中心数据,进行前瞻性研究与外部验证。
本研究借助机器学习算法,成功构建、对比并验证了6种用于预测孕期体重过度增长的模型。其中,GBM预测模型展现出最为卓越的预测性能,彰显了机器学习在疾病预测领域的显著优势。本研究明确指出,孕前体质指数、每日静坐时间、妊娠期糖尿病、孕期抑郁情绪、高龄产妇、孕期体力活动不足以及初产妇为孕期体重过度增长的独立危险因素。此结果为临床干预提供了精准的目标方向,提示应针对上述特定人群开展精准干预措施,以有效预防产妇孕期体重过度增长。尽管作为单中心研究在外部效度方面存在一定局限,但本研究构建的预测模型具有良好的判别效能和临床适用性,为孕期体重管理提供可靠的支持工具。

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2026年第40卷第15期
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doi: 10.12102/j.issn.1009-6493.2026.15.001
  • 接收时间:2025-10-25
  • 首发时间:2026-10-30
  • 出版时间:2026-08-10
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  • 收稿日期:2025-10-25
  • 修回日期:2026-05-03
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    1北京大学人民医院,北京 100044
    2北京大学护理学院

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李森,E-mail:
LI Sen, E-mail:
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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