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.
Highlights
IntroductionThe most controversial aspects are: (a) the need for universal versus selective screening (i.e., only those women with risk factors); (b) the two-step approach using a screening test followed by a diagnostic test versus the one-step approach using only a diagnostic oral glucose tolerance test (OGTT); (c) the most appropriate 4.0/)
The aim of this study is to evaluate the real-life impact of using proposed temporary alternative criteria during the COVID-19 pandemic in a population of pregnant women, and compare the results with the population attended to in the same period in 2019, in order to determine whether women with gestational diabetes mellitus (GDM) diagnosed in each of these periods show differences regarding clinical characteristics and obstetrical and perinatal outcomes
plasma glucose (PG) ≥ 162 mg/dL (9 mmol/L) to diagnose GDM [7]; In Canada [8], those pregnant women with random PG ≥ 200 mg/dL (11 mmol/L) and/or HbA1c ≥ 5.7% (28.5 mmol/mol) have been considered to have GDM; the Australian Diabetes in Pregnancy Society has established that those women with fasting PG ≥ 92 mg/dL (5.1 mmol/L) or with personal history of GDM should be diagnosed with GDM
Summary
The most controversial aspects are: (a) the need for universal versus selective screening (i.e., only those women with risk factors); (b) the two-step approach using a screening test followed by a diagnostic test versus the one-step approach using only a diagnostic OGTT; (c) the most appropriate 4.0/). Test for diagnosis (100 versus 75 g OGTT); and even (d) the proposed cut-off points [1,2]. Considering pregnant women as a high-risk group has made it necessary to perform a temporary reformulation of GDM diagnosis, based on an isolated analytical determination of fasting plasma glucose (PG), random PG, and/or HbA1c [7,8,9,10,11,12,13], in order to avoid pregnant women spending long periods of time at the hospital
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