International Journal of Computational Intelligence Systems (2022) 15:72

https://doi.org/10.1007/s44196-022-00110-8

RESEARCH ARTICLE

Analysis and Prediction of Gestational Diabetes Mellitus

by the Ensemble Learning Method
Xiaojia Wang1 · Yurong Wang1 · Shanshan Zhang2,3 · Lushi Yao1 · Sheng Xu1

Received: 17 November 2021 / Accepted: 18 July 2022

© The Author(s) 2022

Abstract
Gestational diabetes mellitus (GDM) is the most common disease in pregnancy and can cause a series of maternal and infant
complications. A new study shows that GDM affects one in six deliveries. Identifying and screening for risk factors for GDM
can effectively help intervene and improve the condition of women and their children. Therefore, the aim of this paper is to
determine the risk factors for GDM and to use the ensemble learning method to judge whether pregnant women suffer from
GDM more accurately. First, this study involves six commonly used machine learning algorithms to analyze the GDM data
from the Tianchi competition, selects the risk factors according to the ranking of each model, and uses the Shapley additive
interpreter method to determine the importance of the selected risk factors. Second, the combined weighting method was
used to analyze and evaluate the risk factors for gestational diabetes and to determine a group of important factors. Lastly, a
new integrated light gradient-boosting machine-extreme gradient boosting-gradient boosting tree (LightGBM-Xgboost-GB)
learning method is proposed to determine whether pregnant women have gestational diabetes mellitus. We used the gray
correlation degree to calculate the weight and used a genetic algorithm for optimization. In terms of prediction accuracy and
comprehensive effects, the final model is better than the commonly used machine learning model. The ensemble learning
model is comprehensive and flexible and can be used to determine whether pregnant women suffer from GDM. In addition
to disease prediction, the model can also be extended for use to many other areas of research.

Keywords  Gestational diabetes mellitus (GDM) · Machine learning model · Ensemble learning method · The identification
of risk factors for GDM

Abbreviations Xgboost Extreme gradient boosting

GDM Gestational diabetes mellitus RF Random forest
MCH Maternal and child health hospital GB Gradient boosting tree
T2DM Type II diabetes mellitus LightGBM Light gradient boosting machine
IDF International diabetes federation MLP Multilayer perceptron
HIP Hyperglycemia in pregnancy ANN Artificial neural network
DT Decision tree GRA​ Gray relational network
CART​ Classification and regression trees GA Genetic algorithm
BMI Body mass index
HbA1c Hemoglobin a1c
* Sheng Xu SNP Single nucleotide polymorphism
xusheng@hfut.edu.cn DNA Deoxyribonucleic acid
1
Institute of Artificial Intelligence and Data Science, School RBP4 Retinol binding protein 4
of Management, Hefei University of Technology, No. 193, wbc White blood cell
Tunxi Road, Mailbox 270, Hefei 230009, Anhui, China ALT Alanine aminotransferase
2
Department of Clinical Teaching, The First Affiliated AST Alanine aminotransferase
Hospital of Anhui University of Chinese Medicine, Cr Creatinine
Hefei 230031, Anhui, China BUN Blood urea nitrogen
3
The National Chinese Medicine Clinical Research Base-Key CHO Cholesterol
Disease of Diabetes Mellitus Study, Hefei 23003, Anhui, TG Triglyceride
China

13
Vol.:(0123456789)
 72   Page 2 of 20 International Journal of Computational Intelligence Systems
HDLC High density cholesterol
LDLC Low density cholesterol
ApoA1 Apolipoprotein a1
ApoB Apolipoprotein
Lpa Lipoprotein a
hsCRP High-sensitivity C-reactive protein
AUC​ Area under the receiver characteristic curve
TP True positive-it was originally a positive
example, but it is classified as a positive
example
FP False positive-it was originally a positive
example, but it is classified as a positive
example
FN False negative-it was originally a positive
example, but it is classified as a negative
example
TN False negative-it was originally a positive
example, but it is classified as a negative
example
VAR00007 Physical examination indexes after desen-
sitization treatment through reading the
literature, we suspect that VAR00007 is an
insulin resistance index
1 Introduction
This research was motivated by a maternal and child health
care institution that is engaged in providing prenatal care to
pregnant women. The agency found that with the opening
up of the second-child policy and an increasing number of
older pregnant women coupled with substantial improve-
ments in standards of living and continuous improvement of
the dietary structure, the incidence of gestational diabetes
is increasing every year. Therefore, the medical team at this
institution must detect and determine the risk of gestational
diabetes in pregnant women as soon as possible and inter-
vene early to change the pregnancy outcome. For the sake
of confidentiality, the institution is referred to using the fic-
titious name Maternal and Child Health Hospital (MCH).
According to research surveys, in 2019, the total number
of births in China was 14.65 million, and the annual birth
rate was 1.048% [1]. China’s fertility rate is significantly
lower than it was in the past. It is currently not only well
below the global average of 2.45% but also below the level
of 1.67% in developed countries [2]. With the opening up of
the second-child policy and an increasing number of older
pregnant women, coupled with substantial improvements
in standards of living and continuous improvement of the
dietary structure, the incidence of gestational diabetes is
increasing year by year.
Gestational diabetes mellitus (GDM), which is defined as
carbohydrate intolerance of a variable degree with onset or
13
(2022) 15:72
recognition during pregnancy, has recently been identified as
a potential risk factor for type II diabetes mellitus (T2DM)
[3–5]. Compared with normal women, women diagnosed
with GDM are 10 times more likely to develop type 2 dia-
betes, 2.5 times more likely to have ischemic heart disease,
and twice as likely to have hypertension during their later
years [6, 7]. According to International Diabetes Federation
(IDF) statistics, in 2019, one in six births was affected by
GDM [8, 9]. A total of 15.8% (20.4 million) of live births
were by women with hyperglycemia in pregnancy (HIP).
China now has 116.4 million people with diabetes (exclud-
ing Hong Kong, Macao and Taiwan), the highest number
in the world [8]. The development of GDM has been very
severe, and GDM will not only harm pregnant women but
also newborns.
GDM can cause severe complications such as excessive
amniotic fluid, ketoacidosis, preeclampsia, spontaneous
abortion, stillbirth, and secondary infection in pregnant
women as well as fetal malformation hypoglycemia, hyper-
bilirubinemia, and hypocalcemia [3]. Women who develop
gestational diabetes are at higher risk of developing type 2
diabetes later in life. Children exposed in utero are at higher
risk of macrosomia at birth, or of being significantly larger
than average, and of having obesity and type 2 diabetes in
childhood and adulthood. The impact of diabetes on preg-
nant women can be greatly reduced if the risk can be pre-
dicted during the first trimester and timely interventions are
made [10]. It is very important to identify the risk factors
for GDM to predict the risk of pregnant women developing
and suffering from gestational diabetes accurately; moreo-
ver, timely control measures can effectively improve mater-
nal and infant outcomes. Therefore, the motivation of this
study is to support MCH in identifying GDM risk factors
among pregnant women seeking prenatal care and to pre-
dict whether the mother will develop gestational diabetes
accurately.
In research on the pathogenic factors associated with
gestational diabetes, researchers found that the pathogen-
esis of gestational diabetes is complicated and caused by
many factors. The classic explanation of the pathogenic
mechanism is that pregnant women have an increased
need for glucose during pregnancy, but insulin resistance
and insulin secretion are relatively insufficient. Rissanen
[11] et al. study of insulin secretion levels in GDM and
patients with type 2 diabetes found that the deletion of
individual gene loci can trigger GDM and type 2 diabe-
tes. Bao [12] et al. proposed that body mass index (BMI)
values are closely related to pregnant women suffering
from gestational diabetes and found that GDM patients
have a significant increase in the incidence of T2DM in
the future. Minooee [13] et al. found that factors such as
prepregnancy BMI, age, family history of GDM, weight
gain during pregnancy and other factors were risk factors
International Journal of Computational Intelligence Systems
for the occurrence of GDM. Research by Li and Hu et al.
found that advanced age, overweight prepregnancy BMI,
history of diabetes mellitus in first-degree relatives and a
positive rate of thyroid peroxidase antibody are associated
with an increased risk of GDM [14]. Kuzmicki [15] et al.
found that low-grade inflammation can affect the patho-
genesis of GDM. A study by Rezvan [16] et al. showed
that the low plasma adhesin concentration in the patient's
body is related to the blood glucose regulation ability of
hemoglobin A1c (HbA1c). Shaat [17] et al. showed that
polymorphisms of certain alleles affect the disease. There
are many factors that affect diabetes, and it is necessary to
rank the importance of these factors because it is possible
to determine whether a pregnant woman has gestational
diabetes according to the size of the top factors. Early diag-
nosis of pregnant women with disease factors, improved
GDM screening, and early intervention and management
can improve pregnancy outcomes and improve the health
status of newborns.
Many studies have been performed on disease predic-
tion, such as diagnosis, prediction, classification, and ther-
apy. Recent research shows that various machine learning
algorithms have been used for disease identification and
prediction. They have resulted in remarkable efficiency and
improvements in profound conventional and machine learn-
ing [18, 19]. For example, Wu used a tree model and neural
network model algorithm for modeling and data mining
analysis for maternal physical examination indicators [10,
20]. Saloni used the idea of voting integration to predict
diabetes mellitus [21]. Wang used the basic idea of stack-
ing ensemble learning and then adopted three basic mod-
els, namely, random forests, Xgboost and CatBoost, as the
basic learning device and constructed a novel integrated
model for predicting and analyzing gestational diabetes
mellitus [22].
Our main contribution is to use a new integrated Light-
GBM-Xgboost-GB ensemble learning method for mater-
nal and child health care providers to analyze the risk
factors for GDM. This method uses a group of the most
important influencing factors selected through learning
algorithms to identify GDM risk factors accurately and
to predict the possibility of gestational diabetes precisely.
In response to the research problem, the proposed model
improves the existing methodology. This model provides
a comprehensive, practical and flexible method for use
by medical staff during early prenatal care and disease
prediction. Therefore, our model was suggested to be very
useful for medical staff to assess pregnant women with
gestational diabetes.
The paper is organized as follows. In Sect. 2, we will
review some basic knowledge. Section 3 lays the theoretical
foundation for the proposed method. Section 4 describes a
new integrated LightGBM-Xgboost-GB method. In Sect. 5,
(2022) 15:72 Page 3 of 20  72
we first select and analyze the influencing factors, then ana-
lyze the acquired data by applying the model, and sum-
marize the calculation results to verify the model. We then
provide the study conclusions in Sect. 6
2 Preliminary
2.1 Machine Learning Methods
Disease prediction models are closely linked to epidemio-
logical research and clinical practice. In establishing dis-
ease prediction models, the risk factors for disease onset are
linked to the incidence of disease. Some prediction model
studies divide the population into low-risk, medium-risk
and high-risk groups according to the probability of disease
to provide a basis and direction for personalized diagno-
sis and treatment and comprehensive intervention in clini-
cal practice. At present, big data management is not only
widely used in the public domain but has also provided many
studies on the association between big data and disease pre-
diction and uses deep learning, transfer learning and other
algorithms to establish the association between pathogenic
factors and disease probability. With improvements in the
parallel computing ability of big data and the in-depth study
of machine learning models, research using machine learn-
ing models to improve the accuracy of disease prediction is
gradually deepening. With the improvement of data dimen-
sions, making full use of multisource and multidimensional
data has become a trend in disease prediction.
In a study on gestational diabetes prediction models
at home and abroad, Anna Patrick Nomb [20] and other
researchers used the multivariate logistic model in 2018 to
model the probability of GDM risk and concluded that a
family history of stillbirth and type 2 diabetes increased the
prevalence of GDM. Wu [10] et al. established a prediction
model for gestational diabetes mellitus in 2017 by using a
decision tree algorithm. According to the classification and
regression trees (CART) algorithm, we obtained a set of
rule characteristics for the GDM high-risk group. In 2018,
Zhang [23] made the extreme gradient boosting (Xgboost)
algorithm an accurate prediction model for the pathogenic
factors of type two diabetes mellitus. Wang [24] and other
researchers studied the application of the deep learning
model for predicting the risk of type two diabetes in 2017.
With the development of machine learning and big data,
using machine learning algorithms to design diagnosis-aided
decision-making systems provides a prerequisite to meeting
this objective. Therefore, in recent years, many research-
ers have used machine learning algorithms to build disease
prediction reasoning models to assist doctors in diagnosis.
A decision tree (DT) is a basic classifier for which the
two steps are learning and classification [25]. As a machine
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 72   Page 4 of 20 International Journal of Computational Intelligence Systems
learning method, decision trees create an effective model
for data classification and regression [26, 27]. Random for-
est (RF) is an algorithm developed by Breimen and Cut-
ler in 2001. It runs by constructing multiple decision trees
while training and outputting the class. It has improved per-
formance over single decision trees, and it is much more
efficient than traditional machine learning techniques,
especially when the dataset is large [28, 29]. The gradient
boosting tree (GB) is a combination of regression and clas-
sification tree models. GB improves prediction power results
by progressively improving estimations. Additionally, GB
employs a nonlinear regression procedure that helps improve
the accuracy of the trees [30, 31]. Xgboost implements a
gradient boosting framework based on decision trees, which
was proposed by Chen2016 [32]. The library of Xgboost is
designed to be highly efficient, flexible and portable [33].
The light gradient boosting machine (LightGBM) algorithm
is an efficient distributed gradient boosting tree algorithm
[34, 35]. Due to its fast speed, low memory consumption
and relatively high accuracy, it is widely used in classifica-
tion and regression problems [36]. A multilayer perceptron
(MLP), also known as an artificial neural network (ANN),
is a forward structure of artificial neural networks. MLP is
one of the most popular networks and possesses a powerful
ability to solve nonlinear problems and is highly efficient at
calculation [37–39].
These models have become commonly used machine
learning algorithms for predicting gestational diabetes mel-
litus in recent years. In addition, the selection of important
factors in the follow-up research and the base model of the
integration model are from this group of common models.
2.2 Model Fusion Based on Ensemble Learning
In terms of gestational diabetes prediction, research on ges-
tational diabetes was conducted on a single model predic-
tion until 2019. Later, Yu [40] applied an ensemble learning
algorithm in the diagnosis and prediction of gestational dia-
betes mellitus for the first time by using a multi-model fusion
method based on the cascading classifier method. This paper
is focused on the use of three learning algorithms to predict
the prevalence of gestational diabetes mellitus. These three
models are capable of handling small sample sizes, high
missing values, and classification features. On this basis,
while aiming at the optimization problem of model evalua-
tion index and threshold selection, we are the first to propose
that applying the gray correlation method can be used to
calculate the weight value to integrate the three learning
models, optimize the prediction model and improve the suc-
cess rate of diagnosis, which provides a solution for future
research on disease prediction models with poor data quality.
The ensemble learning algorithm is good at addressing
defective data by building multiple classifiers to prevent
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(2022) 15:72
over fitting and improving the performance of the predic-
tion model. In addition to its stability and generalization
ability, the ensemble learning model performs better than
traditional models, and the final prediction accuracy is also
relatively high. At present, some integrated learning models
are applied in other disease predictions, and the effect is
remarkable. Therefore, it is possible to use an integrated
learning algorithm to study the relationship between vari-
ous indicators and the prediction model of the gestational
diabetes mellitus incidence rate.
3 Theoretical Foundation of the Main Model
3.1 Ensemble Learning Methods
In traditional machine learning algorithms, since the mode-
ling process of each single prediction model and the method
of data preprocessing are different, the prediction results of
each single prediction model are different, and the predic-
tion accuracy is also different [28]. A single learner may not
achieve very good results, but if the results of multiple weak
learners are combined, the performance of the model may
be improved to some extent. Therefore, ensemble learning
methods combine a series of different individual learners
through a specific strategy to achieve better learning results.
Ensemble learning methods are divided into stacking, blend-
ing and voting, which are powerful prediction techniques
since they can increase the diversity of algorithms and
reduce generalization errors to improve the accuracy of the
results.
Ensemble learning methods have two basic elements:
one is that the correlation between single models should be
as small as possible, and the other is that the performance
between single models is not too different. In practice, it is
often the case that a single model with a low correlation
coefficient and good performance can significantly improve
the final prediction result. In the research for this article, the
overall model was constructed using the idea of the blending
ensemble method, and the equation is as follows:
n
∑
G(x) = wi gi (x) (1)
i=1
where n is the number of learners and wi is the weight of indi-
∑
vidual learner gi (x) , usually required wi ≥ 0, ni= 1 wi = 1 .
When wi = n , the weighted average becomes a simple aver-
1
age. In fact, the weighted average method can be regarded as
the basic starting point of ensemble learning research. For a
given base learner, different ensemble learning methods can
be regarded as different ways to determine the weight of the
base learner in the weighted average method.
International Journal of Computational Intelligence Systems (2022) 15:72 Page 5 of 20  72

3.2 Traditional Gray Relational Analysis (e) Calculate the degree of association. The correlation
coefficient at each time is concentrated into one value;
Gray system theory is a relational analysis method for sys- that is, the average value is calculated as the quantita-
tem analysis. By comparing the shapes of several curves, it tive expression of the correlation degree between the
is concluded that the more similar the shapes are, the closer comparison series and the reference series. The correla-
the relation they have [41]. Gray relational analysis (GRA) tion degree formula is
is a very important part of gray system theory; it uses the N
similarity and nearness of the sequences to determine the 1∑
ri = 𝜉 (k), k = 1, 2, ..., N (3)
relations among the factors of the system. The original gray N k=1 i
relational analysis model was constructed by Deng Julong
[42], and Liu Sifeng developed the classic gray absolute (f) The correlation between the comparison series and the
degree of gray incidence [43, 44]. Gray relational analysis reference series can be regarded as the contribution of
is useful for managing poor, incomplete, and uncertain infor- a single prediction model to the prediction accuracy.
mation, so it has been widely used in decision-making and Then, calculating the proportion of the single model's
evaluation problems. correlation degree in the total of all the model's correla-
Because the extent of each model that contributes to the tion degrees is the contribution rate of the single model
construction of the ensemble model is different, it was bet- to the integrated model, that is, the weight of the inte-
ter to estimate the relative weight for each model. In model grated model. The weight coefficient of the integrated
fusion, theoretically, the higher the prediction accuracy of a model can be expressed as:
single model is, the greater its contribution to the integrated r
model should be. If a simple weighted average is adopted, wi = ∑n i (4)
r
i=1 i
the contribution of different models to the integration model
is not taken into account. The higher the relative weight was,
the greater the model contribution to the ensemble model Then, the expression of the ensemble model is changed
construction. In fact, GRA is a very useful technique for to:
preference analysis; it effectively measures the relationships �n
ri ri
between one reference sequence and the other comparative ∑n ≥ 0, ∑n = 1 (5)
r i=1 r
sequences. We were motivated to use GRA to estimate the i=1 i i=1 i
relative weight for each model. n
∑
where, ∑n i = 1.
r r
The weighting steps based on gray relational analysis are i=1 ri
≥ 0, ∑n i
i = 1 ri
as follows:
i=1

(a) Determine the analysis sequence. We use the true value 3.3 Genetic Algorithm
of the data as the reference sequence (also known as the
mother sequence) as Y = Y(k)|k = 1, 2, … n; the pre- The gray correlation analysis obtains the relative weight of
dicted value of the model as the comparison sequence each model, which improves the overall performance of the
(also known as the subsequence) is integrated model and can significantly overcome the defects
|
Xi = Xi (k)|k = 1, 2, … n, i = 1, 2, … , m; where k is the of a single model, which is due to the large hypothesis space
| of the learning task, resulting in poor generalization perfor-
number of samples and i is the number of models.
mance and falling into local minima. However, the predic-
(b) Nondimensionalization. Since the parent column and
tion performance of the integrated model still has room for
the child column are 0, 1 label data, no dimensionless
improvement.
processing is required.
The genetic algorithm (GA) was developed using the
(c) Calculate the correlation coefficient. The formula is as
evolutionary theory of biology and genetics. It is a type of
follows:
self-organizing and adaptive artificial intelligence technol-
min min ||x0 (k) − xi (k)|| + 𝜌 × max max ||x0 (k) − xi (k)|| ogy that simulates the evolution process and mechanism of
natural organisms to solve problems. The GA is a random
i k
(2)
i k
𝜉i (k) =
|x (k) − x (k)| + 𝜌 × max max |x (k) − x (k)|
| 0 | k | |
search algorithm that can better improve the optimization
i 0 i
i

(d) 𝜌 ∈ (0, ∞) is called the resolution coefficient. The
smaller ρ is, the greater the resolution. Generally,
the value interval of 𝜌 is (0, 1), and the specific value
depends on the situation. When 𝜌 ≤ 0.5463 , the resolu-
tion is best, usually 𝜌 = 0.5.
of discrete data [45]. Goldberg summarized a unified and
most basic genetic algorithm that uses a selection opera-
tor, crossover operator and mutation operator [45]. The GA
has three unique characteristics: adaptability and versatility,
implicit parallelism, and scalability.

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 72   Page 6 of 20 International Journal of Computational Intelligence Systems (2022) 15:72

Our goal is to minimize the relative error between the studies have used prospective controlled cases to study risk
predicted value and the real value of a single prediction factors for gestational diabetes. However, case studies may
model and the relative error between the predicted value have some particularities, and there may be no association
and the real value of an integrated model. That is, the aver- between cases. In this study, we solved this dilemma. We
age relative error between the overall predicted value and studied a set of the most commonly used machine learning
the real value is the minimum. Therefore, we propose an algorithms to predict gestational diabetes. After comparing
ensemble learning model for target optimization based on their prediction accuracy, we used various classifiers and
genetic calculations: Shapley additive interpreters to identify a set of important
( risk factors to obtain a more objective and reasonable set
[ ] n | i |)
1 ∑ || G (x) − yi || ∑ || gj (x) − yi ||
N i
of routine features for the GDM population. We analyzed
min H gij (x), Gi (x) = | |+ | |
N i=1 || yi |
| j=1 ||
yi | and explained the impact of this group of important factors
|
(6) on the development of gestational diabetes. Then, we used
n ensemble learning methods in machine learning to build
� ri
Subject to Gi (x) = ensemble models and to train predictions. The result of the
∑n gj (x) (7)
j=1 r
i=1 i ensemble learning model is better than that of each indi-
vidual machine learning model.
ri
∑n >0 (8) 4.2 The Ensemble Learning Model
r
i=1 i

n
� ri
∑n = 1
j=1 r
i= 1 i
where i = 1, 2, … , n is the number of samples, j = 1, 2, … , N
is the number of models, gij (x) is the predicted value of a
single model at the sample point, Gi (x) is the predicted value
of the ensemble model at the sample point, and yi is the true
value of the sample point.
4 Model Development for GDM Prediction
4.1 Problem Description of GDM
Maternal and child health care is related not only to the
health of mothers and babies but also to the health status of
the birth population and to the prosperity of the country and
the future of the nation. MCH medical staff are committed to
basic medical services that are closely related to the health
of women and children. Gestational diabetes is a common
phenomenon in female pregnancy, but it has very negative
effects on both women and children, and it must be detected
and controlled early. The pathogenesis of gestational diabe-
tes is complicated and caused by a variety of factors. Among
them, a classic explanation of the pathogenic mechanism
is that pregnant women have an increased need for glucose
during pregnancy, but insulin resistance and insulin secre-
tion are relatively insufficient. Therefore, the medical staff
of MCH urgently need to know the risk factors for gesta-
tional diabetes and to focus on detection and control to avoid
adverse pregnancy outcomes.
The identification of key factors has important clini-
cal significance in GDM risk assessment. Most previous
The ensemble learning model may bring benefits in three
parts. First, from a statistical perspective, by considering
(9)
several models and averaging their predictions, we can
reduce the risk of choosing a very poor model; second, the
integration of multiple models brings the final result closer
to the true value; finally, from the perspective of representa-
tion, the hypothesis space can be expanded, and it is possible
to learn a better approximation.
Ensemble learning methods have two basic elements:
one is that the correlation between single models should be
as small as possible, and the other is that the performance
between single models is not too different. In practice, it is
often the case that a single model with a low correlation
coefficient and good performance can significantly improve
the final prediction result. The GB model is a combination
of regression and classification tree models. Xgboost imple-
ments a gradient boosting framework based on decision
trees. The LightGBM algorithm is an efficient distributed
gradient boosting tree algorithm. In addition, these three
methods are based on the improved tree model. Therefore,
the three classes of algorithms satisfy the diversity, correla-
tion, and performance requirements.
Therefore, we chose GB, Xgboost, and LightGBM as
the base learners and propose a new integrated LightGBM-
Xgboost-GB method, which uses gray correlation to calcu-
late weights and genetic algorithms to optimize them. There-
fore, the n of the final formula for the model is 3.
The specific steps are as follows:
Step 1. Data preprocessing: the original data are preproc-
essed and divided into a training set and a testing set.
Step 2. First, a single model is trained with the train-
ing set, and then the trained model is used to predict the
predicted value of the sample set. Second, the gray corre-
lation coefficient between the predicted value of the j−th

13
International Journal of Computational Intelligence Systems (2022) 15:72 Page 7 of 20  72
prediction model and the observed value of the i−th pre-
dicted sample point is calculated. Lastly, the gray correlation
degree between the predicted value of the model and the
observed value is calculated, and the weight coefficient is
calculated.
Step 3. Determine the fitness function. Calculate the fit-
ness of each individual and determine whether it meets the
optimization criteria. Calculate the average relative error
between the predicted value and the true value, so the fit-
ness function is:
( be regarded as information rather than noise. Therefore, we
3 | i |)
1 ∑ || G (x) − yi || ∑ || gj (x) − yi ||
N i
MAPE = | |+ | | (10)
N i=1 || yi |
| j=1 ||
yi |
| values.
If it is satisfied, output the best individual and the optimal
solution represented by it, and end the algorithm; if not, go
to the next step.
Step 4. Initialize the parameters of the genetic algorithm,
such as the population size, crossover probability, and muta-
tion probability. Parameter optimizations: first, decode the
chromosomes in the population; then, calculate the fitness
value of each generation of the population and perform the
survival of the fittest. Lastly, determine whether the popula-
tion performance satisfies the maximum number of genet-
ics, and if so, the optimal parameter is output; otherwise,
according to the genetic strategy, the selection, crossover
and mutation operations are used to obtain the offspring.
Step 5. Result judgment: if the objective function is satis-
fied, then the optimizations are finished. Otherwise, repeat
step (3).
Step 6. Input the test sample to obtain the best prediction
result. The detailed process is shown in (Fig. 1).
5 Applying the LightGBM‑Xgboost‑GB
Model to Objective Data
5.1 Data Collection
5.1.1 Research Data
The data came from the Tianchi precision medicine competi-
tion on artificial intelligence-assisted genetic risk prediction
of diabetes, which was held by Aliyun United Qingwutong
Health Technology Co. LTD. The first line of the data is the
field name, and each line represents an individual. Some
field names have been identified. The data contain a total of
85 fields and 1200 pieces of data. The data do not include
the time of physical examination and relevant geographic
information. Some field contents are missing for some indi-
viduals, among which the first column is the individual ID
number. The last column of the data is a label column, with
0 indicating no disease and 1 indicating disease, both of
which require a prediction of gestational diabetes. (https://​
tianc​hi.​aliyun.​com/).
Among the 83 original features, only 2 features have no
missing values, and the remaining 81 features are missing to
varying degrees. The general method for addressing miss-
ing values is to delete the missing features, but it cannot be
applied in this sample. The reason is that more than 97% of
the features in this sample are missing, which indicates that
the missing values here have a specific meaning and should
use the mean to fill it in, since the mean will not affect the
overall situation but will also solve the problem of missing
5.1.2 Basic Characteristics
The data contain a total of 85 fields and 1,200 pieces of
data. “Id” is the patient code, and “label” is the classifica-
tion label. Among the 83 variables, there were 55 genetic
variables, all of which were discrete variables, and 28 con-
ventional variables. Of the 28 regular variables, there are
3 discrete variables and 25 continuous variables. Discrete
variables are single nucleotide polymorphism (SNP) gene
site information. SNP genes are widely present in the exist-
ing human genome library, and the average probability is
1/500–1000 base pairs. Amniocentesis during pregnancy
extracts the baby's deoxyribonucleic acid (DNA) and SNP
corresponding gene sites for detection. The physiological
index of a continuous variable indicates that TG represents
triglyceride, which is an index to measure hyperlipidemia;
RBP4 represents retinol binding protein-4. As an adipo-
cytokine, RBP4 participates in obesity and insulin resist-
ance and affects glucose and lipid metabolism in pregnant
women; the BMI index is often used to study whether the
patient is obese or not. In China, 24 and 28 are regarded as
the thresholds of overweight and obesity; HsCRP represents
high-sensitivity C-reactive protein. It is a plasma protein
produced by the liver and is primarily used as a marker of
inflammation. White blood cells (WBCs) are a common
indicator of inflammation during routine blood examina-
tion. Apolipoproteins a1 (ApoA1) and b (ApoB) are apoli-
poproteins that are of great value in the diagnosis of diabe-
tes mellitus complicated with lipid metabolism disorders.
HDLC is high-density lipoprotein cholesterol, and LDLC
is low-density lipoprotein cholesterol. Alanine aminotrans-
ferase (ALT) and aspartate aminotransferase (AST) are two
types of aminotransferase. They are essential catalysts for
human metabolism. They are the two clinical indicators of
liver function testing and play a specific role in the occur-
rence and development of gestational diabetes mellitus. Cr
is creatinine, and CHO is total cholesterol, which are routine
physical examination indices.
13
 72   Page 8 of 20 International Journal of Computational Intelligence Systems
Fig. 1  Calculation steps of the ensemble model
We analyzed and compared the basic characteris-
tics of 25 general variables, and the results are shown
in (Table 1). Continuous variables are expressed as the
mean ± standard deviation (SD), and the characteristic dif-
ferences between the GMD group and the non-GMD group
were tested by using the T test. Compared with patients
who did not have gestational diabetes, gestational diabetes
patients had a higher age, gestational age, prepregnancy
weight, prepregnancy BMI, diastolic blood pressure, sys-
tolic blood pressure, VAR00007, wbc, ALT, CHO, TG,
ApoB, and hsCRP. By contrast, a higher RBP4, BUN, Cr,
HDLC, and LDLC were more common in those without
gestational diabetes.
13
(2022) 15:72
5.2 Collection of Important Variables
5.2.1 Comparison of the Individual Learning Model
We used the accuracy, area under the receiver operating
characteristic curve (AUC), precision, recall and f1-score
to evaluate the performance of the individual models.
The accuracy is the percentage of the data sample that
predicts the correct category.
TP + TN
Accuracy = (11)
TP + FP + TN + FN
The accuracy reflects the correct ability of the model's
category prediction, including two situations: a positive
example is predicted as a positive example, and a negative
International Journal of Computational Intelligence Systems (2022) 15:72 Page 9 of 20  72

Table 1  General characteristics Variable Total (n = 1200) Non-GDM (n1 = 634) GDM (n2 = 566) P-value
of the regular variables
RBP4 22.23 ± 3.23 22.45 ± 2.39 21.99 + 2.96 0.015136
Age 31.79 ± 3.89 31.13 ± 3.76 32.53 + 3.90  < 0.01
Number of pregnancies 1.98 ± 1.00 1.91 ± 0.95 2.05 + 2.06 0.011668
Number of births 1.05 ± 0.22 1.04 ± 0.20 1.06 + 1.25 0.062012
Height 162.26 ± 4.11 162.48 ± 4.01 162.02 + 1.20 0.055647
Prepregnancy weight 57.13 ± 7.83 56.06 ± 7.00 58.32 + 5.52  < 0.01
Prepregnancy BMI 21.67 ± 2.87 21.20 ± 2.40 22.18 + 2.06  < 0.01
Systolic blood pressure 112.99 ± 11.15 111.64 ± 10.69 114.50 + 1.48  < 0.01
Diastolic blood pressure 68.13 ± 7.82 67.88 ± 7.73 69.68 + 6.82  < 0.01
Blood pressure of delivery 73.12 ± 4.31 73.10 ± 4.58 73.15 + 7.98 0.841332
Sugar sieve gestational age 25.46 ± 2.30 25.45 ± 2.17 25.46 + 2.44 0.928622
VAR00007 1.54 ± 0.10 1.50 ± 0.07 1.58 + 1.12  < 0.01
wbc 9.36 ± 1.99 9.12 ± 1.88 9.62 + 9.09  < 0.01
ALT 25.39 ± 26.05 23.71 ± 20.57 27.27 + 2.97 0.018109
AST 37.97 ± 8.23 38.07 ± 7.97 37.86 + 3.52 0.668603
Cr 61.97 ± 5.89 62.04 ± 6.01 61.90 + 6.76 0.671191
BUN 2.84 ± 0.72 2.85 ± 0.70 2.83 + 2.73 0.60111
CHO 6.11 ± 1.54 6.09 ± 0.97 6.12 + 6.00 0.750929
TG 2.54 ± 0.99 2.38 ± 0.90 2.72 + 2.04  < 0.01
HDLC 2.11 ± 0.98 2.12 ± 0.50 2.08 + 2.33 0.464645
LDLC 3.41 ± 2.19 3.49 ± 2.90 3.30 + 3.88 0.13517
ApoA1 3.61 ± 5.71 3.64 ± 5.15 3.58 + 3.29 0.870965
ApoB 1.9 ± 6.55 1.81 ± 2.53 2.00 + 2.16 0.610646
Lpa 206.83 ± 196.87 206.80 ± 186.82 206.87 + 2.71 0.995141
hsCRP 4.16 ± 20.55 3.14 ± 2.36 5.30 + 5.80 0.069232

example is predicted as a negative example. When we pay
the same attention to category 1 and category 0 (the category
is symmetric), the accuracy is a good evaluation index.
The area under the receiver operating characteristic curve
(AUC); as the name implies, the AUC value is the area under
the receiver operating characteristic curve. Typically, AUC
values range from 0.5 to 1.0, and a larger AUC represents a
better performance.
The precision rate is the proportion of the actual positive
examples in the sample predicted to be positive examples.
TP
Precision =
TP + FP
The precision rate reflects the prediction ability of the
model on the positive case, which focuses on the positive
case. If we pay attention to the prediction accuracy of the
positive case, the precision rate is a good indicator.
The recall rate is the proportion of the predicted positive
sample in the real positive sample.
TP
Recall =
TP + FN
The recall rate reflects the coverage of the model in the
correct prediction of positive examples, which is a little like
“no fish is allowed to escape the net”. If we focus on the
comprehensiveness of the prediction of positive samples, the
recall rate is a good indicator. The recall rate is not affected
by the sample proportion imbalance because it only focuses
on the prediction of the positive sample.
The F1-score is a model evaluation index that takes into
account both the accuracy and recall rate, which is defined as
2 ∗ Precision ∗ Recall
f1 − score = (14)
Precision + Recall
(12)
When there is no special requirement for the precision or
recall rate, it is necessary to consider both the precision rate
and recall rate when evaluating a model, and the F1-score
can be considered.
Here, the data sample can be binarily classified into posi-
tive and negative categories. Then, there are 4 combinations
of the predicted results and the real tags TP, FP, FN, and TN,
as shown in (Fig. 2).
(13) Table  2 shows the comparison results for individual
machine learning algorithms. As indicated by the output

13
 72   Page 10 of 20 International Journal of Computational Intelligence Systems (2022) 15:72

Fig. 2  The confusion matrix

results, the Xgboost model has high scores in terms of accu-
racy, AUC value, recall rate, recall accuracy and f1-score,
making it the best prediction model. When we pay the same
attention to category 1 and category 0 (the category is sym-
metric), the accuracy is a good evaluation index. When there
is no special requirement for the precision or recall rate, it is
necessary to consider both the precision rate and recall rate
when evaluating a model, and the f1-score can be consid-
ered. Thus, we use the accuracy and the F1-score as the main
evaluation indicators of the model, as shown in (Fig. 3), for a
comparison of the accuracy and the F1-score of each model.
5.2.2 Risk Factor Selection of GDM
Table 3 shows the top 20 variables in the ranking of impor-
tance for each algorithm variable. Variable VAR00007
appears many times at the top of the list, in addition to other
factors, such as SNP34, TG, and SNP37. Pregestational
weight and pregestational BMI were listed as important influ-
encing factors of GDM in most models, which may reflect the
relationship between obesity and GDM. Systolic blood pres-
sure and diastolic blood pressure were also listed as important
factors in GDM in most models, indicating that hypertension
has a specific influence on the development of GDM.
Fig. 3  Comparison of the accuracy and the F1-score of each model
We use the principle underlying the Shapley value
method and use the ranking value of different factors in dif-
ferent models as the contribution value of a factor in differ-
ent models, and then the weighting factor is one-sixth. The
important factors from each model were re-ranked, and the
final ranking results of importance were obtained, as shown
in (Table 3). The risk factors for the GDM risk score include
age, genetic factors, prepregnancy body mass index, number
of pregnancies, blood pressure and other factors, which are
also listed as important variables in our study.
To study the importance of the risk factor variables in ges-
tational diabetes, we projected twenty important variables that
were selected by the machine learning algorithm onto a four-
quadrant matrix. Figure 4 shows the quadrants of four important
variables based on Shapley’s ranking of the importance of vari-
ables (higher rankings are at the bottom) and comprehensive
weighting (smaller weights are on the left). The ranking of the
Shapley method on the importance of variables is shown in
(Table 4). The comprehensive weight is shown in (Table 5)
(the comprehensive weight obtained by the expert scoring
method, where 0 is unimportant, 5 is generally important and
10 is very important). The horizontal line dividing the upper

Table 2  Comparison results Model Accuracy AUC​ Recall Precision f1-score

of individual machine learning
algorithms GB Train 0.8789 0.8761 0.8259 0.9093 0.8656
Test 0.7000 0.6909 0.5390 0.7525 0.6281
LightGBM Train 0.8533 0.8493 0.7765 0.8992 0.8333
Test 0.7200 0.7102 0.5461 0.7938 0.6471
MLP Train 0.5426 0.5537 0.7466 0.5101 0.6061
Test 0.5250 0.5351 0.7368 0.5000 0.5957
RF Train 0.7700 0.7613 0.6047 0.8682 0.7129
Test 0.6867 0.6759 0.4965 0.7527 0.5983
Xgboost Train 0.8889 0.8866 0.8467 0.9112 0.8778
Test 0.7533 0.7516 0.7183 0.7500 0.7338
DT Train 0.8057 0.8023 0.7435 0.8272 0.7831
Test 0.6367 0.6295 0.5106 0.6429 0.5692

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International Journal of Computational Intelligence Systems (2022) 15:72 Page 11 of 20  72

Table 3  The top 20 ranked variables for each algorithm

Rank Machine-learning algorithms
GB LightGBM MLP RF Xgboost DT

1 VAR00007 VAR00007 VAR00007 VAR00007 VAR00007 VAR00007

2 SNP34 hsCRP SNP34 SNP34 Age SNP34
3 TG SNP37 Age TG wbc wbc
4 SNP37 TG BMI before pregnancy Age TG TG
5 Age Age TG BMI before pregnancy SNP37 ApoB
6 wbc wbc Weight before pregnancy SNP37 hsCRP HDLC
7 hsCRP SNP34 BMI classificatio hsCRP SNP34 AST
n
8 Cr Cr Systolic blood pressure Systolic blood pressure AST wbc
9 AST Lpa wbc Diastolic blood pressure Cr SNP42
10 HDLC BUN Diastolic Weight before BMI before Height
blood pregnancy pregnancy
pressure
11 SNP20 BMI before Number of LDLC HDLC CHO
pregnancy pregnancy
12 Systolic ALT ALT Cr ALT Number of
blood pregnancy
pressure
13 CHO ApoB SNP46 RBP4 Height hsCRP
14 SNP38 CHO SNP32 CHO BUN Cr
15 BMI before Diastolic SNP42 ALT ApoB BMI befor
pregnancy blood pregnancy
pressure
16 SNP42 Weight before SNP13 ApoA1 Systolic Age
pregnancy blood
pressure
17 SNP48 ApoA1 Number of Number of Diastolic SNP23
births births blood
pressure
18 Sugar sieve RBP4 SNP40 Number of SNP23 ApoA1
gestational pregnancy
age
19 SNP23 LDLC hsCRP HDLC RBP4 ALT
20 SNP27 AST SNP17 ApoB CHO RBP4

and lower quadrants is based on the median value of Shap-
ley's ranking, while the vertical line is the median value of the
weight. The lower right quadrant is the quadrant with the high-
est rankings and highest weights. The factors in this quadrant
are very important for the development of gestational diabetes.
By contrast, the upper left quadrant contains factors with low
rankings and low weights. Comparatively speaking, these fac-
tors are related to the development of gestational diabetes. The
remaining two quadrants correspond to abnormal points with
high ranking and low weight or low ranking and high weight.
5.2.3 Attractive Variables (First Quadrant)
We found that ApoA1, ApoB, and the number of pregnan-
cies were present in the first quadrant with high weight and
low ranking. Recent studies have shown that ApoA1 and
ApoB are apolipoproteins. Apolipoproteins can play a role
in stabilizing the structure of lipoproteins by binding and
transporting lipids, regulating the activities of key lipopro-
tein enzymes and participating in the key link of lipopro-
tein metabolism. The combined detection of apolipoprotein
ApoA1 and ApoB is of great value in diagnosing diabetes
mellitus complicated with lipid metabolism disorders and
helps guide the treatment and prognosis of diabetes. Studies
have also shown that pregnant women have a greater risk
of having a higher prepregnancy BMI, and the interaction
caused by the parity of pregnant women cannot be ignored.
Body mass index (BMI) and parity are the main risk factors
for pregnant women to develop gestational diabetes [46].
Second, overweight or obesity is a risk factor for gestational
diabetes [47]. In addition, parity can increase the impact

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 72   Page 12 of 20 International Journal of Computational Intelligence Systems (2022) 15:72

Fig. 4  Quadrant distribution of
20 variables

Table 4  Variable ranking based Model GB LightGBM MLP RF Xgboost DT Mean rank

on the Shapley value
Feature importance rank VAR00007 1 1 1 1 1 1 1.00
SNP34 2 7 2 2 7 2 3.67
TG 3 4 5 3 4 4 3.83
SNP37 4 3 6 5 3 4.20
Age 5 5 3 4 2 16 5.83
wbc 6 6 9 3 8 6.40
hsCRP 7 2 19 7 6 13 9.00
BMI befor 15 11 4 5 10 15 10.00
pregnancy
Cr 8 8 12 9 14 10.20
Weight 16 6 10 10.67
before
pregnancy
Systolic 12 8 8 16 11.00
blood
pressure
HDLC 10 19 11 6 11.50
AST 9 20 17 8 7 12.20
Diastolic 15 10 9 17 12.75
blood
pressure
ApoB 13 20 15 5 13.25
Number of 11 18 12 13.67
pregnancy
ALT 12 12 15 12 19 14.00
CHO 13 14 14 20 11 14.40
ApoA1 17 16 18 17.00
RBP4 18 13 19 20 17.50

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International Journal of Computational Intelligence Systems (2022) 15:72 Page 13 of 20  72

Table 5  Variable weight based Variable Expert1 Expert2 Expert3 Expert4 Mean Weight
on expert scoring
VAR00007 10 5 10 10 8.75 0.0875
SNP34 10 10 5 5 7.5 0.075
TG 5 10 5 10 7.5 0.075
SNP37 10 5 10 5 7.5 0.075
Age 10 15 5 10 10 0.1
wbc 5 5 5 5 5 0.05
hsCRP 5 5 5 5 5 0.05
Prepregnancy BMI 5 10 5 10 7.5 0.075
Cr 0 5 5 0 2.5 0.025
Prepregnancy Weight 5 0 5 10 5 0.05
Systolic blood pressure 0 5 5 5 3.75 0.0375
HDLC 0 10 5 0 3.75 0.0375
AST 5 0 0 0 1.25 0.0125
Diastolic blood pressure 0 5 5 5 3.75 0.0375
ApoB 0 0 5 0 1.25 0.0125
Number of pregnancies 5 5 5 10 6.25 0.0625
ALT 5 0 0 0 1.25 0.0125
CHO 5 0 0 0 1.25 0.0125
ApoA1 5 0 5 0 2.5 0.025
RBP4 10 5 10 10 8.75 0.0875
Total 100 100 100 100 100 1

of overweight and obesity on gestational diabetes. Pregnant
women with more recent last pregnancies will have rela-
tively weak physical function and a relatively low metabolic
rate, thus impairing glucose tolerance. The incidence of dia-
betes and other diseases is relatively high. The predictability
of these three factors on machine learning algorithms may
not be as good as other factors, but their impact on gesta-
tional diabetes has received more attention from scholars in
recent years.
5.2.4 Least Preferred Variables (Second Quadrant)
Women who are obese are not choosing a good time to
become pregnant. Cholesterol is a common clinical lipid
metabolism hormone that can reflect abnormal lipid metabo-
lism. If the body’s lipid metabolism is disordered, it will
lead to abnormal glucose metabolism. The reason is that the
serum cholesterol level may cause the progression of insu-
lin resistance. RBP4 is a new type of adipocytokine and a
type of secreted retinol binding protein that transports retinol
through the liver and blood circulation. Studies have shown
that improving serum RBP4 levels is essential for improv-
ing insulin sensitivity and maintaining blood sugar stabil-
ity. HDLC can control glucose homeostasis through insulin
secretion and direct glucose uptake by amp-activated protein
kinase in the muscles and possibly enhance insulin sensitiv-
ity. Studies have shown that the higher the HDLC is, the
lower the risk of gestational diabetes. Through a literature
search, we found that ALT, AST, diastolic blood pressure
and systolic blood pressure also play a role in the develop-
ment of gestational diabetes (for details about the literature,
please refer to Appendix Tables 6, 7).
5.2.5 Potential Variables (Third Quadrant)
There was only one factor in the third quadrant, Cr (creati-
nine). Previous studies have shown that Cr is susceptible to
interference from external stimuli. As long as the kidney has
a strong compensatory function, the Cr level can be main-
tained in the normal range. Therefore, this indicator can only
be used as an auxiliary indicator and has little significance
for early diagnosis. However, machine learning algorithm
prediction research has shown that Cr has important predic-
tive value in predicting gestational diabetes [48]. In addition,
recent studies by scholars have shown and believed that the
combined detection of serum albumin, beta-2-microglobu-
lin, non-esterified fatty acids and Cr, four indicators, has a
significant effect on GDM disease in addition to high diag-
nostic efficiency, especially for the early diagnosis of dis-
ease, dynamic monitoring of index factor expression differ-
ences and the sustainable monitoring of disease progression.
5.2.6 Important Variables (Fourth Quadrant)
Factors such as the prepregnancy BMI, TG, age, VAR00007,
hsCRP, wbc, SNP34 and SNP37 belong to the fourth

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Fig. 5  a Monotonicity of Prepregnancy, TG, Age and VAR00007. b Monotonicity of hsCRP, wbc, SNP34 and SNP37

13
International Journal of Computational Intelligence Systems
quadrant, which is a group of factors with higher weight
and higher ranking. From the data, we found that the higher
the value of the factors, the greater the risk of disease, as
shown in (Fig. 5). Through the study of previous research
literature, we have indeed found that these factors play an
important role in the development of gestational diabetes
(for details about the literature, please refer to Appendix
Tables 6, 7). In other words, obese pregnant women, older
Fig. 6  Comparison results on the index accuracy and F1-score
Fig. 7  Radar map showing a
comparative analysis of differ-
ent methods
(2022) 15:72 Page 15 of 20  72
pregnant women and pregnant women with lower physical
fitness have a higher risk of gestational diabetes.
Therefore, the variables VAR00007, SNP34, TG, age,
SNP37, wbc, hsCRP, and prepregnancy BMI were the fac-
tors that had the greatest impact on pregnant women suffering
from gestational diabetes. In addition, Cr is a latent variable
that requires more attention. Although scholars have recently
believed that ApoA1, ApoB and the number of pregnancies
also have an important impact on gestational diabetes, their
importance is far less than that of VAR00007, SNP34, TG
and other factors. When SNP34 and SNP37 were 2, the
incidence of GDM was relatively high, and the higher the
VAR00007 was, the more prone to gestational diabetes the
woman was; through reading the literature, we suspect that
VAR00007 is an insulin resistance index.
5.3 Analysis of Predicted Results
5.3.1 Result of the Ensemble LightGBM‑Xgboost‑GB Model
We calculated the gray correlation coefficient between
the predicted value of the j−th prediction model and the
observed value of the i−th predicted sample point, thereby
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 72   Page 16 of 20 International Journal of Computational Intelligence Systems
calculating the gray correlation degree between the predicted
value of the model and the observed value.
The correlations between the predicted value and the
true value of the LightGBM, Xgboost, and GB models
calculated by gray correlation analysis are r1 = 0.631407 ,
r2 = 0.631814 , and r3 = 0.631407 , respectively. In using
the normalized value of the gray correlation degree as the
coefficient value of the combined model,w1 = 0.33262 ,
w2 = 0.33476  , and w3 = 0.33262 are obtained. Then, a
genetic algorithm is used to optimize the integrated model
coefficient parameters, and the final weight values are
w1 = 0.2130 , w2 = 0.5320 and w3 = 0.2550.
After the combined model coefficients are obtained,
the test sample is input to obtain the best prediction result.
Table 8 compares the prediction correctness of the ensemble
learning model with each individual learning algorithm. The
comparison results are shown in (Fig. 6).
Compared with the LightGBM, Xgboost and GB algo-
rithms, the proposed ensemble blending learning method
has the best performance.
5.3.2 Comparative Analysis Using Other Ensemble
Methods
Ensemble learning methods are divided into stack-
ing, blending and voting, which are powerful predic-
tion techniques since they can increase the diversity of
algorithms and reduce generalization errors to improve
the accuracy of the results. We refer to other methods
about the ensemble model of pregnancy diabetes pre-
diction [21, 22]. Unlike our ensemble blending method,
other articles use the voting method and the stacking
method. Therefore, to show that the method for the
ensemble blending model is better, we ensemble Light-
GBM, Xgboost and GB models with the voting method
and stacking method and then predict the same dataset
again. The final prediction results are shown in (Table 9
and Fig. 7).
5.4 Conclusion
From the results of Table 9 and Fig. 7, we can conclude
that the result of the ensemble model obtained by the mixed
mode is better than the other two methods. Therefore, we
believe that the new integrated model has a good effect in
predicting gestational diabetes mellitus. Although the pre-
diction accuracy of the new integrated model is 2.56 per-
centage points higher than that of a single best model, the
prediction accuracy of the new integrated model is of great
benefit to the prediction of gestational diabetes mellitus. It
is possible to improve the accuracy of the diagnosis of the
13
(2022) 15:72
disease to improve maternal and infant outcomes as early
as possible.
Gestational diabetes mellitus is a common disease during
pregnancy. Therefore, it is necessary to identify this dis-
ease as soon as possible. This research primarily verifies
the accuracy of the commonly used machine learning algo-
rithms used in several gestational diabetes mellitus cases in
the past and obtains the best ensemble prediction method for
predicting diabetes mellitus. The results also show that our
proposed ensemble method is better.
6 Discussion
This paper proposes a new integrated LightGBM-Xgboost-
GB method to help MCH detect and determine the risk of
GDM in pregnant women and to take measures to control
pregnancy outcomes. We analyzed and compared several
risk prediction models for characterizing the risk of devel-
oping GDM. To predict gestational diabetes, we paid more
attention to determining whether a pregnant woman has ges-
tational diabetes according to the examination results. To our
knowledge, this is the first study to assess the importance of
variables and to characterize the risk of developing GDM
using different machine learning methods. Our results were
consistent with previous findings. From the research conclu-
sions of many scholars, the age, BMI, WBC, hsCRP, RBP4,
weight, calpain-10 gene, and TG were important risk factors.
Our results also revealed their prominent presence on the top
10 key factors for GDM.
The identification of key factors has important clinical
significance in GDM risk assessment. We used Shapley's
idea to rank the importance of the feature variables of each
model comprehensively to obtain a more objective and rea-
sonable set of routine features for the GDM population. In
the past ten years, the detection of various indicators has
matured very rapidly. Therefore, when assessing the risk of
gestational diabetes, MCH medical staff need to pay more
attention to these important factors.
Most importantly, we propose a new integrated model
that uses gray correlation to calculate weights and a genetic
algorithm to optimize them. Using an ensemble model com-
posed of the Xgboost, GB and LightGBM algorithms, the
results are encouraging. In terms of prediction accuracy
and comprehensive effects, the final model is better than the
commonly used machine learning models. Our main con-
tribution is reflected in two parts. First, some scholars have
used the traditional regression tree analysis method to study
the prediction model of gestational diabetes mellitus, but
few studies have integrated multiple models to predict ges-
tational diabetes mellitus. Therefore, this research focuses on
the integration of LightGBM, Xgboost and GB algorithms.
International Journal of Computational Intelligence Systems (2022) 15:72 Page 17 of 20  72

These three models have strong processing abilities for small

samples, many missing values and classification features.
It provides a solution for disease prediction models with
poor data quality. Second, some scholars have established a
model explanation for gestational diabetes mellitus based on
physiological indicators but have not accounted for genetic
factors. Some studies have shown that genetic factors are
Fl-score

also the cause of gestational diabetes mellitus. In practice,

0.6471
0.7338
0.6281
0.7534 we hope to improve the diagnostic accuracy and work effi-
ciency of doctors and reduce the negative impact of missed
diagnosis and misdiagnosis. Second, this research idea
provides a research case in the direction of disease predic-
tion, enriches the application of artificial intelligence in the
medical field, and provides ideas for disease diagnosis and
prediction research.
However, several limitations should be mentioned. First,
Precision

0.7938
0.7500
0.7525
0.7570

the examination time and region of the patients in these data

were unknown, and the analysis results may be different by
time and region. Second, we must perform future research
with external validation and other machine learning methods
to assess the important characteristic variables. In addition,
it is difficult to explain the inherent complexity of variable
interactions and their impacts on outcomes because of the
“black box” nature of machine learning methods.
In conclusion, this study is based on machine learning
0.5461
0.7183
0.5390
0.7500
Recall

methods that were used to predict the early occurrence of

gestational diabetes, which will help MCH staff diagnose
the risk of diabetes in pregnant women in a timely manner
and provide a basis for preventive intervention and treatment
of GDM. By using a series of machine learning models, we
used Shapley's idea to rank the importance of the feature
variables of each model comprehensively to obtain a rule
feature set of GDM high-risk groups with higher objectiv-
ity and rationality. We analyzed and explained the impact of
0.7102
0.7516
0.6909
0.7765
AUC​

this group of important factors on the development of gesta-

tional diabetes. Our results demonstrate the excellent ability
of machine learning to identify risk factors and to predict
the results of multidimensional data, which enables us to
have a deeper understanding of disease risk factors without
causation. This paper verifies the feasibility and effective-
ness of the multimodal combination prediction model for the
accurate diagnosis of gestational diabetes through theoretical
Accuracy

research and experimental analysis. It has made practical

0.7200
0.7533
0.7000
0.7792
Table 8  Comparison results of models

contributions to the study of intelligent recognition models

for gestational diabetes, but there are still deficiencies in
the research or some issues that are not well considered. In
today's medical industry, the digitalization of hospitals is
gradually increasing. The popularity of electronic medical
Ensemble methods
LightGBM
Xbboost
Model

GB

13
 72   Page 18 of 20 International Journal of Computational Intelligence Systems (2022) 15:72

records and the digitization of medical equipment have

further increased the amount and scope of medical data.
With their rapid accumulation and scale growth, the era
of medical big data has arrived. In this case, the artificial
intelligence method represented by machine learning stud-
ied in this article can provide support for scientific medical
decision-making and promote the healthy development of
F1-score

China's medical service industry.

0.7195
0.6792
0.6982

Electronic supplementary material  The online version of this article

(https://d​ oi.o​ rg/1​ 0.1​ 007/s​ 44196-0​ 22-0​ 0110-8) contains supplementary
material, which is available to authorized users.

Acknowledgements  This work was supported by a grant from the

Key Disease of Diabetes Mellitus Study Center at the National Chi-
nese Medicine Clinical Research Base, the National Natural Science
Foundation of China grant Nos. U2001201 and 61876055 and National
Precision

Steering Committee for Graduate Education of Chinese Medicine and

0.7570
0.6316
0.7195

Traditional Chinese Medicine grant No. 20190723-FJ-B39.

Author contributions  XW, YW, SZ, LY, and SX: contributed to the
conception of the study; YW: performed the simulation experiment;
XW: contributed significantly to the model; SX, YW, and SZ: per-
formed the data analyses and wrote the manuscript; and LY and SX:
helped perform the analysis with constructive discussions.

Data availability  The data came from the Tianchi precision medicine
competition, artificial intelligence-assisted genetic risk prediction of
0.7500
0.6316
0.7087

diabetes, which was held by Aliyun United Qingwutong Health Tech-

Recall

nology Co. LTD. (https://​tianc​hi.​aliyun.​com/).

Declarations 

Conflict of Interest  The authors declare that they have no conflict of

interest.

Ethical Approval and Consent to Participate  The data used in this paper
is a public data set without ethical experiments.
Table 9  Comparison of prediction results for different ensemble methods

0.7765
0.7765
0.7297
AUC​

Consent for Publication  The authors involved in this paper agree to

publish this paper.

Open Access  This article is licensed under a Creative Commons Attri-

bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
Accuracy

included in the article's Creative Commons licence, unless indicated

0.7792
0.7472
0.7306

otherwise in a credit line to the material. If material is not included in

the article's Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/.

References
Blending
Stacking

1. National Bureau of Statistics. Birth Rate[DB/OL]. http://​www.​

Voting
Model

stats.​gov.​cn/​2021. Accessed 2021

13
International Journal of Computational Intelligence Systems
2. OCED.Global fertility in developed countries[DB/OL]. https://​
www.​oecd.​org/.​2021. Accessed 2021
3. Stewart, Z.A.: Gestational diabetes[J]. Obstet. Gynaecol. Reprod.
Med. 30(3), 79–83 (2020)
4. Wang, X., Chen, M., Xia, W., Zhu, K., et  al.: Improving the
risk management of Type 2 diabetes mellitus in China from the
perspective of social relationships[J]. Expert. Syst. 37(2), 1–18
(2020)
5. Wang, X., Gong, W., Zhu, K., et al.: Sequential prediction of
glycosylated hemoglobin based on long short-term memory with
self-attention mechanism[J]. Int. J. Comput. Intell. Syst. 13(1),
1578–1589 (2020)
6. Vounzoulaki, E., Khunti, K., Abner, S.C., et al.: Progression to
type 2 diabetes in women with a known history of gestational
diabetes: Systematic review and meta-analysis[J]. Br. Med. J.
369(1361), 1–11 (2020)
7. Zheng, W.: Case control study of gestational diabetes mellitus
influential factors and maternal and fetal outcomes[D]. Master
thesis. China Medical University, pp. 1–10 (2009)
8. Care, D., Suppl, S.: Classification and diagnosis of diabetes:
Standards of medical care in diabetesd-2019[J]. Diabetes. Care.
42(1), 13–28 (2019)
9. Cheruku, R., Edla, D.R., Kuppili, V.: Diabetes classification using
radial basis function network by combining cluster validity index
and BAT optimization with novel fitness function[J]. Int. J. Com-
put. Intell. Syst. 10(1), 247–265 (2017)
10. Wu, B., Huang, H., Yao, Q., et al.: The application of big data and
artificial intelligence methods in prediction of GDM[J]. Chin J.
Health. Inform. Manag. 114(6), 832–837 (2017)
11. Rissanen, J., Markkanen, A., et al.: Sulfonylurea receptor 1 gene
variants are associated with gestational diabetes and type 2 dia-
betes but not with altered secretion of insulin[J]. Diabetes. Care.
23(1), 70–73 (2000)
12. Bao, W., Yeung, E., Tobias, D.K., et al.: Long-term risk of type
2 diabetes mellitus in relation to BMI and weight change among
women with a history of gestational diabetes mellitus: a prospec-
tive cohort study[J]. Diabetologia 58(6), 1212–1219 (2015)
13. Minooee, S., Ramezani Tehrani, F., et al.: Diabetes incidence
and influencing factors in women with and without gestational
diabetes mellitus: A 15 year population-based follow-up cohort
study[J]. Diabetes Res. Clin. Pract. 128(1), 24–31 (2017)
14. Li, F., Hu, Y., Zeng, J., et al.: Analysis of risk factors related to
gestational diabetes mellitus[J]. Taiwan. J. Obstet. Gynecol. 59(5),
718–722 (2020)
15. Kuzmicki, M., Telejko, B., Szamatowicz, J., et al.: High resistin
and interleukin-6 levels are associated with gestational diabetes
mellitus[J]. Gynecol. Endocrinol 25(4), 258–263 (2009)
16. Rezvan, N., Hosseinzadeh Attar, M.J., Masoudkabir, F., et al.:
Serum visfatin concentrations in gestational diabetes mellitus and
normal pregnancy[J]. Arch. Gynecol. Obstet. 285(5), 1257–1262
(2011)
17. Shaat, N., Karlsson, E., Lernmark, A., et al.: Common variants in
MODY genes increase the risk of gestational diabetes mellitus[J].
Diabetologia 49(7), 1545–1551 (2006)
18. Kumar, D., Jain, N., Khurana, A., et al.: Automatic detection of
white blood cancer from bone marrow microscopic images using
convolutional neural networks[J]. IEEE Access 8(1), 142521–
142531 (2020)
19. Mittal, M., Arora, M., Pandey, T., Goyal, L.M.: Image segmenta-
tion using deep learning techniques in medical images[M]. Algor.
Intell. Syst. (2019). https://d​ oi.o​ rg/1​ 0.1​ 007/9​ 78-9​ 81-1​ 5-1​ 100-4_3
20. Nombo, A.P., Mwanri, A.W., et al.: Gestational diabetes mellitus
risk score: a practical tool to predict gestational diabetes mellitus
risk in Tanzania[J]. Diabetes Res. Clin. Pract. 145(8), 130–137
(2018)
(2022) 15:72 Page 19 of 20  72
21. Kumari, S., Kumar, D., Mittal, M.: An ensemble approach for
classification and prediction of diabetes mellitus using soft voting
classifier[J]. Int. J. Cognitive Comput. Eng. 2(1), 40–46 (2021)
22. Wang X.: Application of integrated learning in gestational dia-
betes mellitus prediction[D]. Master thesis. Chongqing Normal
University, pp. 14–25 (2020)
23. Zhang, H., He, G., Wang, J.: Research on type 2 diabetes mellitus
precise prediction models based on XGBoost algorithm[J]. China.
Exp. Diagn. 22(3), 408–412 (2018)
24. Wang, X., Wang, X., Li, L.: Application of deep learning model
in predicting the risk of type 2 diabetes mellitus[J]. Elect. J. Clin.
Med. Liter. 4(84), 16460–16461 (2017)
25. Lan, T., Hu, H., Jiang, C., et al.: A comparative study of decision
tree, random forest, and convolutional neural network for spread-F
identification[J]. Adv. Space Res. 65(8), 2052–2061 (2020)
26. Begenova, S., Avdeenko, T.: Building of fuzzy decision trees
using ID3 algorithm[J]. J. Phys: Conf. Ser. 1015(2), 22002–22009
(2018)
27. Qiao, W., Tian, W., Tian, Y., et al.: The forecasting of PM2.5 using
a hybrid model based on wavelet transform and an improved deep
learning algorithm[J]. IEEE Access 7(7), 142814–142825 (2019)
28. Lu, Y., Fu, X., Chen, F., et al.: Prediction of fetal weight at var-
ying gestational age in the absence of ultrasound examination
using ensemble learning[J]. Artif. Intell. Med. 102(101748), 1–10
(2020)
29. Li, X.: Using, “ random forest ” for classification and regression[J].
Chin. J. Appl. Entomol 50(4), 1190–1197 (2013)
30. Lombardo, L., Cama, M., Conoscenti, C., et al.: Binary logistic
regression versus stochastic gradient boosted decision trees in
assessing landslide susceptibility for multiple-occurring landslide
events: application to the 2009 storm event in Messina (Sicily,
southern Italy)[J]. Nat. Hazards 79(3), 1621–1648 (2015)
31. Ye, J, Chow, J-H, Chen, J.: Stochastic Gradient Boosted Distrib-
uted Decision Trees[C]. Proceedings of the 18th ACM Conference
on Information and Knowledge Management, 2061–2064 (2009)
32. Chen, T, Guestrin, C.: XGBoost: A scalable tree boosting
system[C]. International Conference on Knowledge Discovery
and Data Mining, 785–794 (2016)
33. Yue, L., Yi, Z., Pan, J., et al.: Identify M Subdwarfs from M-type
Spectra using XGBoost[J]. Optik 225(2), 165535.1-165535.6
(2021)
34. Sharma, V., Mir, R.N.: An enhanced time efficient technique for
image watermarking using ant colony optimization and light gra-
dient boosting algorithm[J]. J. King Saud Univ – Comput. Inf. Sci.
34(3), 615–626 (2019)
35. Ke, G, Meng, Q, Finley, T.: LightGBM: A Highly Efficient Gra-
dient Boosting Decision Tree[C]. Adv Neural Inf Process Syst,
3146–3154 (2017)
36. Del Ser, J., Rokach, L., Herrera, F., et al.: A practical tutorial
on bagging and boosting based ensembles for machine learning:
Algorithms, software tools, performance study, practical perspec-
tives and opportunities[J]. Inf. Fusion. 64(1), 205–237 (2020)
37. Zeng, X., Yeung, D.S.: Hidden neuron pruning of multilayer per-
ceptrons using a quantified sensitivity measure[J]. Neurocomput-
ing 69(4), 825–837 (2006)
38. Shadkani, S., Abbaspour, A., Samadianfard, S., et al.: Compara-
tive study of multilayer perceptron-stochastic gradient descent and
gradient boosted trees for predicting daily suspended sediment
load: The case study of the Mississippi River, U.S.[J]. Int. J. Sedi-
ment. Res. 36(4), 512–523 (2021)
39. Wang, X., Wang, J., Zhang, K., et al.: Convergence and objective
functions of noise-injected multilayer perceptrons with hidden
multipliers[J]. Neurocomputing 452(7), 796–812 (2020)
40. Jianyu Y.: Research on Predictive Model of Gestational Diabetes
Based on Integrated Learning Algorithm[D]. Master thesis. Har-
bin Institute of Technology, pp. 37–46 (2019)
13
 72   Page 20 of 20 International Journal of Computational Intelligence Systems
41. Yang, M., Deng, M.H., et al.: (2010) Research on index weight
based on improved grey relational analysis[J]. Int. Conf. Mach.
Learning Cybern. 4(1), 1967–1970 (2010)
42. Deng, J.: Grey information space[J]. J. Grey. Syst. 1(2), 103–117
(1989)
43. Fang, Z., Liu, S., Forrest, J.: A new definition for the degree of
grey incidence[J]. Sci. Inq. 7(2), 111–124 (2006)
44. Jana, C., Pal, M.: A dynamical hybrid method to design decision
making process based on GRA approach for multiple attributes
problem[J]. Eng. Appl. Artif. Intell. 100(82), 104203.1-104203.10
(2021)
45. Dong, X., Zhang, H., et al.: Hybrid genetic algorithm with varia-
ble neighborhood search for multi-scale multiple bottleneck trave-
ling salesmen problem[J]. Futur. Gener. Comput. Syst. 114(3),
229–242 (2021)
13
(2022) 15:72
46. Huo, Z., Li, H., Du, W.: The effect of pre-pregnancy BMI and
parity on gestational diabetes mellitus among pregnant women[J].
J. Clin. Pathol. Res. 36(2), 161–167 (2016)
47. Paula Bertoli, J.P., Schulz, M.A., et al.: Obesity in patients with
gestational diabetes: Impact on newborn outcomes[J]. Obes. Med.
20(1), 100296.1-100296.5 (2020)
48. Mishra, S., Shetty, A., Rao, C.R., et al.: Risk factors for gestational
diabetes mellitus: A prospective case-control study from coastal
Karnataka[J]. Clin. Epidemiol. Glob. Health. 8(4), 1082–1088
(2020)
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