Temporary changes in clinical guidelines of gestational diabetes screening and management during COVID-19 outbreak: A narrative review

Abstract

Background and aims: New clinical approaches are needed to minimize complications of gestational diabetes during the COVID-19 outbreak with timely screening and proper management. The present study aims to highlight changes in the clinical guideline for gestational diabetes during the pandemic. Methods: In a narrative review, multiple databases were searched. Furthermore, online searches were conducted to identify guidelines or support documents provided by NGOs, local health authorities, and societies and organizations in the field of diabetes and obstetrics. Results: We included five national guidelines that were published in English from Canada, the United Kingdom, Australia, New Zealand, and Australia health agencies. FBG, A1C, RPG were recommended as alternative tests instead of a 2-h oral glucose tolerance test (OGGT) for GDM screening at 24e28 weeks of gestation. Recommendations also included a deferral of postpartum screening till the end of the pandemic, or postponement of testing to 6e12 months after delivery, use telemedicine and telecare. Conclusions: Updated temporary changes in clinical guidelines are sensible and accommodates social distancing and minimizes risk of exposure to COVID-19. Despite many unsolved controversies in screening, treatment, and follow-up of gestational diabetes, it seems involvement with novel coronavirus have made a reach to a global agreement simpler.

Management of Diabetes in Pregnancy During COVID-19 Pandemic

“…During COVID-19 pandemic, there will be temporary changes to the recommended process of diagnostic testing for gestational diabetes during pregnancy and for postnatal checks in women who have had gestational diabetes [5]. The rationales for the suggestion of these temporary measures are shortening the screening test process to reduce risk of exposure to COVID-19 in laboratories; reducing the burden on pathology centers, diabetes care providers and obstetric team; minimizing the number of visits and duration of stay in the hospital for pregnant women; and reducing in-person visit by replacing such visits with remote communication with patients [2].…”

“…Additionally, there may be an increased risk of adverse pregnancy outcomes, such as preterm birth, among pregnant women with COVID-19 [1]. The anatomical structure of the respiratory system is changed during pregnancy, and the virus transmitted by droplets and aerosols is more easily inhaled by pregnant women and is difficult to remove [2]. Changes in reproductive hormones and immune systems during pregnancy collectively make them more susceptible to certain infections.…”

Gestational diabetes during COVID 19 pandemic: Major problem is diagnosis

“…In this letter, we want to present a reality that occurs in countries with a high prevalence of coronavirus disease 2019 (COVID-19), in which the main issue of gestational diabetes is the diagnosis, because oral glucose tolerance test (OGTT), which is the gold standard [ 2 , 3 ], implies high risks of exposure and a burden for health services [ 1 , 3 ].…”

“…Due to this issue, various guidelines have updated their screening criteria for gestational diabetes, using fasting plasma glucose (FBG), HbA1c and random plasma glucose tests with greater flexibility and availability [ 2 ]. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Australasian Diabetes in Pregnancy Society, recommend that an HbA1c ≥ 5.9% and/or an FBG level ≥5.1 mmol/L in the first trimester are considered diagnostic criteria for GDM, and that OGTT is only required when the FBG level is between 4.7 and 5.0 mmol/L [ 1 , 2 ]. The diagnosis of GMD during this period of pregnancy should not cause any difficulties.…”

“…In relation to GMD screening during 24–28 weeks of gestation, RANZCOG considers an FBG level of >5.1 mmol/L as the diagnostic criterion, whereas the Australasian Diabetes in Pregnancy Society also recommends performing an FBG test using the same cut-off point and considering OGTT only for women with an FBG level between 4.7 and 5.0 mmol/L [ 2 ]. The poor specificity and high number of false positives of FBG restricts its efficiency for screening; however, a benefit is that it may be useful to decide which patient requires OGGT and thus reduces their requirement by 50% [ 4 ].…”