Abstract: Objective To explore the risk factors of fetal growth restriction (FGR) in patients with gestational diabetes, and to construct and validate the risk prediction model. 
Methods The medical records of 256 pregnant women with gestational diabetes who delivered in Changzhou Maternal and Child Health Hospital from December 2018 to December 2023 were retrospectively analyzed, and were divided into training set (n=204) and validation set (n=52) according to an 8〖DK〗∶2 ratio. According to restriction of FGR, they were divided into abnormal group and normal group, the risk factors of FGR in patients with gestational diabetes were screened, and the risk prediction model was constructed and verified. 
Results Among 204 patients with gestational diabetes, 22 had intrauterine growth restriction (IUGR), with an incidence of 10.78% (22/204). The glycated hemoglobin A1c (HbA1c), systolic peak velocity (S)/diastolic peak velocity (D), resistance index (RI), and soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) of the abnormal group were higher than those of the normal group (P＜0.05), and the flow mediated dilation (FMD) of the brachial artery was lower than that of the normal group (P＜0.05). HbA1c (OR=3.601, 95%CI: 1.511-8.578), S/D (OR=3.307, 95%CI: 1.388-7.879), RI (OR=3.714, 95%CI: 1.558-8.848), sVEGFR-1 (OR=3.425, 95%CI: 1.437-8.159), FMD (OR=0.212, 95%CI: 0.089-0.506) were risk factors for FGR in patients with gestational diabetes (P＜0.05). The sensitivity of the risk model to predict the occurrence of FGR in diabetic patients during pregnancy in the training set was 0.823 (95%CI: 0.729-0.908), the specificity was 0.826 (95%CI: 0.751-0.916), and the area under the curve (AUC) was 0.884 (95%CI: 0.819-0.945). The sensitivity, specificity, and AUC of the risk model for predicting the occurrence of FGR in pregnant women with diabetes were 0.731 (95%CI: 0.643-0.861), 0.825 (95%CI: 0.712-0.907), and 0.818 (95%CI: 0.726-0.913) respectively. 
Conclusion The changes of HbA1c, S/D, RI, sVEGFR-1 and FMD levels are related to the occurrence of FGR in patients with gestational diabetes. Constructing a risk prediction model is helpful to identify the risk of FGR at an early stage. 

Key words: diabetes, gestational, fetal growth restriction, influencing factor, risk prediction model