Impact of the Gestational Diabetes Diagnostic Criteria during the Pandemic: An Observational Study

Abstract

Objective: To analyze the effect of applying alternative diagnostic criteria for gestational diabetes mellitus (GDM) during the COVID-19 pandemic on GDM prevalence and obstetrical and perinatal outcomes, in comparison to usual diagnostic approaches. Methods: Data from women referred to GDM diagnosis from 1 September to 30 November 2019 were retrospectively collected (2019-group). The same data from the same period in 2020 were prospectively collected (2020-group). In both cases, a two-step diagnostic approach was used, the first step being a screening test (1 h 50 goral glucose tolerance test, OGTT). In 2019 it was followed by a 100 gr OGTT for diagnosis. In 2020, this was replaced by a blood test for the measurement of plasma glucose and HbA1c, according to alternative GDM diagnostic criteria during the COVID-19 pandemic. Results: From 237 women in the 2019 group, 40 (16.9%) were diagnosed with GDM, while from 255 women in the 2020 group, 37 (14.5%) had GDM (p = 0.470). More women in the 2020 group, in comparison to the 2019 group, were nulligravid (41.9% vs. 47.2%, p = 0.013), had a personal history of GDM (11.4% vs. 4.6%, p = 0.013) and had macrosomia in previous pregnancies (10.2% vs. 2.1%, p = 0.001). Obstetrical and perinatal outcomes were similar when comparing women with GDM to non-GDM women in the 2019 and 2020 groups and between GDM women and non-GDM women. Conclusion: In a Spanish population, GDM prevalence during the COVID-19 pandemic using the alternative diagnostic criteria was similar to that found in 2019 using the usual diagnostic criteria. Despite women referred for GDM diagnosis during the pandemic having more GDM risk factors, obstetrical and perinatal outcomes were comparable to those observed before the pandemic.

Impact of COVID‐19 on gestational diabetes pregnancy outcomes in the UK: A multicentre retrospective cohort study

“…Our findings do not support retrospective studies that modelled pregnancy outcomes associated with the emergency GDM care pathways, and suggested that adverse outcomes may be increased because women who would have normally been diagnosed with GDM may be ‘missed’ 16 . Consistent with our findings is a prospective study in Spain that found that the rate of missed diagnoses of GDM did not substantially change when comparing conventional criteria used before the pandemic with alternative diagnostic criteria used during the pandemic 38 . A nationwide cohort study of 948 020 singleton births in England, comparing maternal and neonatal outcomes for the general maternity population during COVID‐19 and in the year prior, found an increase in obstetric intervention 39 .…”

“…16 Consistent with our findings is a prospective study in Spain that found that the rate of missed diagnoses of GDM did not substantially change when comparing conventional criteria used before the pandemic with alternative diagnostic criteria used during the pandemic. 38 A nationwide cohort study of 948 020 singleton births in England, comparing maternal and neonatal outcomes for the general maternity population during COVID-19 and in the year prior, found an increase in obstetric intervention. 39 We had no information about whether women were included in both Pre-and COVID populations and so were not able to adjust for this in our analyses.…”

Association of COVID-19 Lockdown With Gestational Diabetes Mellitus

“…Meanwhile, a prospective study by Molina-Vega et al. found that the rate of missed diagnosis of GDM did not substantially change when comparing conventional criteria used before the pandemic with alternative diagnostic criteria used during the COVID-19 pandemic ( 42 ). Therefore, more studies are needed to examine the effects of diagnosis criteria on the association between COVID-19 lockdown and GDM.…”

Impact of a modified screening approach during the COVID‐19 pandemic on the diagnosis and outcomes of gestational diabetes mellitus: A population‐level analysis of 90,518 pregnant women

“…17 Most of the studies examining the impact of modified screening protocols are based on either cohorts of women prior to the pandemic or single-centre experiences. 6,10,[17][18][19][20][21][22][23] There are currently limited real-world data on the uptake of the modified screening guidelines, their impact on the rates of GDM diagnosis and associated outcomes at the population level.…”

“…The study found that women who had a missed GDM diagnosis had worse pregnancy and neonatal outcomes than women with no GDM for both the modified UK and Canadian guidelines, but not the modified Australian criteria 17 . Most of the studies examining the impact of modified screening protocols are based on either cohorts of women prior to the pandemic or single‐centre experiences 6,10,17‐23 . There are currently limited real‐world data on the uptake of the modified screening guidelines, their impact on the rates of GDM diagnosis and associated outcomes at the population level.…”