Study protocol on risk factors for the diagnosis of gestational diabetes mellitus in different trimesters and their relation to maternal and neonatal outcomes (GDM-RIDMAN).

INTRODUCTION: Gestational diabetes mellitus (GDM) is often associated with adverse pregnancy outcomes. However, the association of risk factors with GDM diagnosis, maternal and neonatal health outcomes is less established when compared with women without GDM. We aim to examine the diagnostic accuracy of the conventional and novel risk factors for a GDM diagnosis and their impact on maternal and neonatal health outcomes. METHODS AND ANALYSIS: This retrospective cohort and nested case-control study at six public health clinics is based on medical records and questionnaire survey of women between 2 and 12 months postpartum. The estimated required sample size is 876 complete records (292 cases, 584 control, at a ratio of 1:2). Oral glucose tolerance test results will be used to identify glucose dysregulation, and maternal and neonatal outcomes include maternal weight gain, pre-eclampsia, polyhydramnios, mode of delivery, preterm or postdate birth, complications in labour, birth weight, gestational age at birth, Apgar score, congenital anomaly, congenital hypothyroidism, neonatal death or stillbirth, hypoglycaemia and hyperbilirubinaemia. Psychosocial measures include the WHO Quality of Life: brief, mother-infant bonding (14-item Postpartum Bonding Questionnaire and 19-item Maternal Postnatal Attachment Scale), anxiety (7-item Generalised Anxiety Disorder), depression (9-item Patient Health Questionnaire) and stress (Perceived Stress Scale symptoms) questionnaires. The comparative incidences of maternal and neonatal health outcomes, the comparative prevalence of the psychosocial outcomes between women with GDM and without GDM, specificity, sensitivity, positive and negative predictive values of the risk factors, separately and combined, will be reported. All GDM risk factors and outcomes will be modelled using multivariable regression analysis and the receiver operating characteristics curve will be reported. ETHICS AND DISSEMINATION: This study was approved by the Malaysia Research and Ethics Committee, Ministry of Health Malaysia. Informed consent will be obtained from all participants. Findings will be submitted for publications in scientific journals.

Effects of Movement Control Order (MCO) During Covid-19 Pandemic on Patients With Diabetes Mellitus (DM) in Malaysian Tertiary Centers

Introduction: The Malaysian government implemented MCO or lockdown for nearly 3 months from 18 Mar to 9 Jun 2020 in response to the Covid-19 pandemic. This restricted access to usual food, workplace, and leisure sports, and also led to reduced clinic attendance. The effects of MCO on patients with chronic lifestyle diseases like DM is unknown. Methodology: This is a cross-sectional study exploring effects of MCO on adult (>18 years) DM patients (both Type 1 and Type 2) attending endocrinologist-run DM clinics in 3 tertiary centres in Malaysia. Glycaemic and metabolic parameters were collected through medical record review while data on healthcare utilisation, dietary and lifestyle habits before MCO (17 Nov 2019 to 17 Mar 2020) and during MCO were collected by investigator-administered questionnaires during routine clinic follow-up after the MCO period (10 Jun to 30 Oct 2020). Results: From a total of 207 patients (56.5% female, 73.4% T2D and 80% on insulin) no significant difference between mean (SD) A1c [8.6(2.39) % vs 8.4(2.14) %;p=0.073] or BMI [29.2(7.57) vs 29.4(9.23)kg/m2;p=0.968] were seen before and during MCO respectively. More than 95% of the patients attended clinic before MCO and at least 20.3% saw either the DM nurse educator, DM pharmacist or dietitian. In contrast, during MCO only 31.4% of patients attended clinic and less than 10% had face-to-face consultation with the DM support team. More patients also reported missing insulin (11.6% vs 7.7%) and not checking blood glucose (17.9% vs 15.5%) during MCO. Before MCO, 61.8% of patients had home-cooked food daily. During MCO this increased to 83.1%. However, there was a trend towards unhealthy eating during MCO. Patients reported eating more frequently with those eating more than 4 meals a day nearly tripled during MCO (18.4% vs 6.8%). In addition, 22% of patients recalled consuming more confectionary;a similar percentage also reported higher consumption of processed food like dry snacks, canned food and instant noodles during MCO. Mean (SD) hours of sleep [6.8 (1.35) vs 7.2 (1.73) hours;p<0.001] and screen time [3.3 (2.51) vs 4.51 (3.10] hours, p<0.001) increased significantly during MCO compared to before. Notably, before MCO 44% of patients reported no exercise and this increased to 65.7% during MCO. Conclusion: Despite reduced clinic attendance and contact with the DM support team, there were no consequent significant change in A1c or BMI of our DM patients from the 3-month MCO in our short term study. However, a worrying increase in sedentariness and unhealthy eating existed. The imperative need to conduct work or lessons online, among others contributed to the inevitable rise in screen time and reduced physical activity. As the pandemic continues with imposed movement restrictions, the long-term implications of MCO to metabolic health warrant our attention. Innovative strategies to promote healthier living during MCO are urgently needed.