Factors Influencing Wound Complications After Cesarean Section in Women With Gestational Diabetes Mellitus: Development and Validation of a Prediction Model

AIM: To investigate factors influencing wound complications after cesarean section in women with gestational diabetes mellitus (GDM) and to develop a predictive model. METHODS: A retrospective study was conducted, including 600 women with GDM who underwent cesarean delivery at The Maternal and Child Health Care Hospital of Tongxiang between January 2022 and February 2025. Participants were randomly divided into a training set (n = 420) and a validation set (n = 180) at a 7:3 ratio. Clinical variables for model development included age, body mass index (BMI), hypertension status, glycated hemoglobin (HbA1c), albumin level, and time to first postoperative ambulation. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors and establish the predictive model. The discriminative performance of the model was evaluated using the receiver operating characteristic (ROC) curve, while calibration curves and decision curve analysis (DCA) were applied to evaluate calibration and clinical utility, respectively. RESULTS: Wound complications occurred in 108 patients (18%). Multivariate analysis identified concurrent hypertension (odds ratio (OR) = 2.63, 95% CI: 1.30–5.33), elevated BMI (OR = 1.07, 95% CI: 1.01–1.15), increased HbA1c (OR = 1.76, 95% CI: 1.34–2.33), decreased albumin level (OR = 0.84, 95% CI: 0.78–0.91), and delayed time to first ambulation (OR = 1.17, 95% CI: 1.07–1.28) as independent risk factors for wound complications (all p < 0.05). The multivariable logistic regression model demonstrated good discrimination, with an area under the curve (AUC) of 0.78 (95% CI: 0.72–0.83) in the training set and 0.78 (95% CI: 0.69–0.87) in the validation set. Calibration and decision curve analyses indicated good agreement and clinical net benefit. CONCLUSIONS: This study developed and internally validated a predictive model incorporating five readily available clinical indicators. The model may assist in identifying women with GDM at increased risk of poor incision outcomes following cesarean section and support risk stratification and early clinical decision-making.