Comparison of the clinical characteristics, glycemic control, and pregnancy outcomes between women with gestational diabetes mellitus in waves I and III of the COVID-19 pandemic: a reference center report
Abstract
Objectives: The medical care of patients with gestational diabetes mellitus (GDM) during the COVID-19 pandemic was influenced by changing epidemiological conditions and government regulations. Aim — To compare the clinical pregnancy data of GDM women between waves I and III of the pandemic. Material and methods: We performed a retrospective analysis of medical records from the GDM clinic and compared the periods of March–May 2020 (wave I) and March–May 2021 (wave III). Results: Women with GDM during wave I (n = 119) compared to wave III (n = 116) were older (33.0 ± 4.7 vs 32.1 ± 4.8 years; p = 0.07), booked later (21.8 ± 8.4 vs 20.3 ± 8.5 weeks; p = 0.17), and had their last appointment earlier (35.5 ± 2.0 vs 35.7 ± 3.2 weeks; p < 0.01). Telemedicine consultations were used more frequently during wave I (46.8% vs 24.1%; p < 0.01), while insulin therapy was used less often (64.7% vs 80.2%; p < 0.01). Mean fasting self-measured glucose did not differ (4.8 ± 0.3 vs 4.8 ± 0.3 mmol/L; p = 0.49), but higher postprandial glucose was reported during wave I (6.6 ± 0.9 vs 6.3 ± 0.6 mmol/l; p < 0.01). Pregnancy outcome data were available for 77 wave I pregnancies and 75 wave III pregnancies. The groups were similar in terms of gestational week of delivery (38.3 ± 1.4 vs 38.1 ± 1.6 weeks), cesarean sections (58.4% vs 61.3%), APGAR scores (9.7 ± 1.0 vs 9.7 ± 1.0 pts), and birth weights (3306.6 ± 457.6 g vs 3243.9 ± 496.8 g) (p = NS for all). The mean wave I neonate length was slightly higher (54.3 ± 2.6 cm vs 53.3 ± 2.6 cm; p = 0.04). Conclusions: We identified differences between wave I and wave III pregnancies for several clinical characteristics. However, nearly all pregnancy outcomes were found to be similar.
Keywords: diabetesgestational diabetes mellitusGDMcoronaviruspregnancy
References
- Blumenthal D, Fowler EJ, Abrams M, et al. Covid-19 - Implications for the Health Care System. N Engl J Med. 2020; 383(15): 1483–1488.
- Murphy HR. Managing Diabetes in Pregnancy Before, During, and After COVID-19. Diabetes Technol Ther. 2020; 22(6): 454–461.
- Sweeting A, Wong J, Murphy HR, et al. A Clinical Update on Gestational Diabetes Mellitus. Endocr Rev. 2022; 43(5): 763–793.
- Chehab RF, Ferrara A, Greenberg MB, et al. Glycemic Control Trajectories and Risk of Perinatal Complications Among Individuals With Gestational Diabetes. JAMA Netw Open. 2022; 5(9): e2233955.
- Torlone E, Sculli MA, Bonomo M, et al. Recommendations and management of hyperglycaemia in pregnancy during COVID-19 pandemic in Italy. Diabetes Res Clin Pract. 2020; 166: 108345.
- Justman N, Shahak G, Gutzeit O, et al. Lockdown with a Price: The impact of the COVID-19 Pandemic on Prenatal Care and Perinatal Outcomes in a Tertiary Care Center. Isr Med Assoc J. 2020; 22(9): 533–537.
- Kleinwechter HJ, Weber KS, Mingers N, et al. COVID-19-Related Obstetric and Neonatal Outcome Study (CRONOS) Network. Gestational diabetes mellitus and COVID-19: results from the COVID-19-Related Obstetric and Neonatal Outcome Study (CRONOS). Am J Obstet Gynecol. 2022; 227(4): 631.e1–631.e19.
- Bociąga-Jasik M, Wojciechowska W, Terlecki M, et al. Comparison between COVID‑19 outcomes in the first 3 waves of the pandemic: a reference hospital report. Pol Arch Intern Med. 2022; 132(10).
- Wilk M, Surowiec P, Matejko B, et al. Diabetes Management Delivery and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus during the First Wave of the 2020 COVID-19 Pandemic: A Single-Reference Center Report. J Diabetes Res. 2021; 2021: 5515902.
- Guidelines on the management of patients with Diabetes. A position of Diabetes Poland. Curr Top Diabetes. 2022; 2(1): 1–134.
- Virtanen P, Gommers R, Travis E, et al. Fundamental Algorithms for Scientific Computing in Python. Nature Methods. 2020; 17(3): 261–272.
- Sagan A, Bryndova L, Kowalska-Bobko I, et al. A reversal of fortune: Comparison of health system responses to COVID-19 in the Visegrad group during the early phases of the pandemic. Health Policy. 2022; 126(5): 446–455.
- Pinkas J, Jankowski M, Szumowski Ł, et al. Public Health Interventions to Mitigate Early Spread of SARS-CoV-2 in Poland. Med Sci Monit. 2020; 26: e924730.
- Eleftheriades M, Chatzakis C, Papachatzopoulou E, et al. Prediction of insulin treatment in women with gestational diabetes mellitus. Nutr Diabetes. 2021; 11(1): 30.
- Wong VW, Jalaludin B. Gestational diabetes mellitus: who requires insulin therapy? Aust N Z J Obstet Gynaecol. 2011; 51(5): 432–436.
- Bertini A, Gárate B, Pardo F, et al. Impact of Remote Monitoring Technologies for Assisting Patients With Gestational Diabetes Mellitus: A Systematic Review. Front Bioeng Biotechnol. 2022; 10.
- Eberle C, Stichling S. Telemedical Approaches to Managing Gestational Diabetes Mellitus During COVID-19: Systematic Review. JMIR Pediatr Parent. 2021; 4(3): e28630.
- American Diabetes Association Professional Practice Committee. 15. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022; 45(Suppl 1): S232–S243.
- Byström M, Liu A, Quinton AE, et al. Gestational Diabetes Independently Increases Birth Length and Augments the Effects of Maternal BMI on Birth Weight: A Retrospective Cohort Study. Front Pediatr. 2014; 2: 112.
- Nachtergaele C, Vicaut E, Pinto S, et al. COVID-19 pandemic: Can fasting plasma glucose and HbA1c replace the oral glucose tolerance test to screen for hyperglycaemia in pregnancy? Diabetes Res Clin Pract. 2021; 172: 108640.
- Meek CL, Lindsay RS, Scott EM, et al. Approaches to screening for hyperglycaemia in pregnant women during and after the COVID-19 pandemic. Diabet Med. 2021; 38(1): e14380.