ENDOCRINOLOGY IN THE TIME OF COVID-19: Diagnosis and management of gestational diabetes mellitus

Abstract

<jats:p>The COVID-19 pandemic has required rapid transformation and adaptation of healthcare services. Women with gestational diabetes mellitus (GDM) are one of the largest high-risk groups accessing antenatal care. In reformulating the care offered to those with GDM, there is a need to balance the sometimes competing requirement of lowering the risk of direct viral transmission against the potential adverse impact of service changes. We suggest pragmatic options for screening of GDM in a pandemic setting based on blood tests, and risk calculators applied to underlying risk factors. Alternative models for antenatal care provision for women with GDM, including targeting high-risk groups, early lifestyle interventions and remote monitoring are provided. Testing options and their timing for postpartum screening in women who had GDM are also considered. Our suggestions are only applicable in a pandemic scenario, and usual guidelines and care pathways should be re-implemented as soon as possible and appropriate.</jats:p>

Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence?

“…Thangaratinam, 2020 [49] Test strategy: The "single test procedure" for diagnosing GDM: 2 h PG ≥ 7.8 mmol/L with 75 g oral glucose administered to a pregnant woman in the fasting or non-fasting state, without regard to the time of the last meal (glucose load can also be taken at home and the pregnant woman can visit the hospital 2 h after the glucose ingestion to give a single sample for plasma glucose estimation)…”

“…When an OGTT is not possible, as an alternative RPG, FPG and HbA1c are recommended. Thangaratinam et al [49] suggested additional tests at booking to detect overt diabetes and identify those at highest risk for GDM. HbA1c ≥ 6.5% or RPG ≥ 11.1 mmol/L is considered as pre-existing diabetes.…”

Management of gestational diabetes in women with a concurrent severe acute respiratory syndrome coronavirus 2 infection, experience of a single center in Northern Italy

“…We expect to increase our study sample in the following months and thus provide further results. The main strength of this study is that it was conducted in one of the six reference centres for the treatment of COVID-19 in women in Lombardy, the first region to be affected by the disease in Europe and one of the areas with the highest diffusion rate of infection [1][2][3][4][5][6][7][8][9][10].…”

“…In northern Italy, one of the first areas in Europe to be hit by the pandemic, the virus has spread significantly among the pregnant population 1 . Repercussions on prenatal care, especially of high‐risk pregnancies, are yet to be analyzed 1‐3 …”

Consensus Scientific Statement on Advisory Working Guidelines and Recommendations for the Female Population in COVID-19 Era by WINCARS

“…An HbA1c cut-off of 5.9% and above, when measured by the National Glycohemoglobin Standardization Program (NGSP), certified method has been recommended to diagnose GDM during the pandemic. [95][96][97][98][99] Any acute medical or surgical illness can precipitate an adrenal crisis episode in patients who have long-standing adrenal insufficiency. This is true for the COVID-19 infection as well.…”