JMIR Publications

ABSTRACT

Background:

Gestational diabetes mellitus (GDM) significantly increases the risk of developing type 2 diabetes mellitus (T2DM) postpartum, with up to half of affected women progressing within a decade. Early identification of high-risk individuals is critical for implementing preventive interventions. Artificial intelligence (AI) offers enhanced predictive capabilities that can substantially enhance the prevention of postpartum diabetes.

Objective:

This systematic review and meta-analysis aimed to evaluate the performance of AI models in predicting the progression from GDM to T2DM or prediabetes (PreDM).

Methods:

Seven databases (MEDLINE, EMBASE, Scopus, Web of Science, IEEE Xplore, ACM Digital Library, and Google Scholar) were systematically searched from inception through September 12, 2025, supplemented by backward and forward reference screening and biweekly alerts to capture newly published studies. This review included peer-reviewed English-language studies that applied AI algorithms to predict T2DM or PreDM among women with prior GDM. Eligible studies focused on human participants, reported performance metrics (e.g., accuracy, sensitivity, specificity) and excluded non-AI models, animal studies, reviews, protocols, abstracts, and non-English publications. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the PROBAST+AI tool. Pooled estimates were computed using random-effects meta-analysis models.

Results:

Ten studies met inclusion criteria, of which eight were eligible for meta-analysis. The reviewed studies spanned from 2011 to 2025 and were conducted across seven countries, predominantly in the United States (30%). Most publications were journal articles (90%), and retrospective designs (60%) were slightly more common than prospective designs (40%). AI models demonstrated high predictive performance for T2DM, with pooled accuracy of 0.85 (95% CI 0.79-0.90), sensitivity of 0.89 (95% CI 0.81-0.95), specificity of 0.88 (95% CI 0.81-0.93), F1-score of 0.80 (95% CI 0.75-0.85), and AUC of 0.86 (95% CI 0.77-0.91). However, AI performance for PreDM prediction was modest (AUC=0.69). Subgroup analyses showed that Random Forest, Decision Tree, Logistic Regression, and Naïve Bayes models performed comparably. Fasting plasma glucose (FPG) and body mass index (BMI) were the most identified significant predictors in the included studies.

Conclusions:

AI models show potential in predicting T2DM after GDM. However, evidence remains limited by small sample sizes, high heterogeneity, lack of external validation, and high risk of bias. Unlike prior reviews that included non-AI models or lacked quantitative synthesis, this study offers a robust evaluation of model performance across diverse AI approaches. It advances the field by identifying consistent predictors and highlighting key methodological gaps. These findings have important implications for digital health, supporting the integration of AI-driven risk prediction into electronic health record systems and postpartum care pathways to enable early identification, targeted prevention, and improved long-term outcomes. Future research should employ large, diverse cohorts, integrate multidimensional data, adopt standardized reporting frameworks, and encourage open-access data sharing to enhance model reliability and clinical applicability in postpartum diabetes prevention.