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1.
Front Public Health ; 10: 850191, 2022.
Article in English | MEDLINE | ID: covidwho-1785450

ABSTRACT

Objective: To investigate whether first-trimester fasting plasma glucose (FPG), blood coagulation function and lipid metabolism could predict gestational diabetes mellitus (GDM) risk. Methods: From October 2020 to May 2021, a total of 584 pregnant women who took prenatal care in Shanghai Jiaotong University Affiliated Sixth People's Hospital were chosen as the observation subjects. The clinical information and serum samples of all pregnant women were collected at 10-13 weeks of gestation and the blood coagulation function, fasting blood glucose and lipid profiles of the pregnant women were detected. A 75 g oral glucose tolerance test was performed up to 24-28 weeks of gestation. One hundred forty-two pregnant women with GDM and 442 pregnant women without GDM were detected. Data were expressed by x ± s or median (interquartile range) and were analyzed using student's t-test, Wilcoxon rank sum test and Logistic regression analysis. The area under the curve (AUC) was calculated by receiver operating characteristic curve (ROC) to analyze the predictive values. Results: Compared with non-GDM group, age, pre-pregnancy BMI, FPG, FIB, D-Dimer, FDP, FPG, TC, TG, LDL-C, sdLDL-C, APOB and APOE in GDM group were significantly higher than those in non-GDM group, while PT, INR, APTT and TT were significantly lower than those in non-GDM group. Univariate logistic regression analysis was used to explore the risk factors of GDM. Gestational age, pre-pregnancy BMI, FPG, PT, INR, APTT, FIB, TT, D-Dimer, TC, TG, LDL-C, sdLDL-C, APOB and APOE were all independent predictors of GDM. Multivariatelogistic regression showed that pre-pregnancy BMI, FPG, APTT, TT, TG, LDL-C, sdLDL-C and APOB were risk factors for GDM. The AUC of the established GDM risk prediction model was 0.892 (0.858-0.927), and the sensitivity and specificity were 80.71 and 86.85%, respectively; which were greater than that of pre-pregnancy BMI, FPG, APTT, TT,TG, LDL-C, sdLDL-C, APOB alone, and the difffference was statistically signifificant (P < 0.05). Conclusions: FPG, APTT, TT, TG, LDL-C, sdLDL-C, APOB and pre-pregnancy BMI in early pregnancy has important clinical value for the prediction of GDM, We combined these laboratory indicators and established a GDM risk prediction model, which is conducive to the early identification, intervention and treatment of GDM, so as to reduce the morbidity of maternal and infant complications.


Subject(s)
Diabetes, Gestational , Apolipoproteins B/metabolism , Apolipoproteins E/metabolism , Blood Coagulation , Blood Glucose/analysis , Blood Glucose/metabolism , Body Mass Index , Cholesterol, LDL/metabolism , Diabetes, Gestational/diagnosis , Early Diagnosis , Female , Glycolipids , Humans , Lipid Metabolism , Pregnancy
2.
Int J Environ Res Public Health ; 19(3)2022 Feb 08.
Article in English | MEDLINE | ID: covidwho-1674643

ABSTRACT

BACKGROUND: Due to COVID-19, many centres adopted a change to the diagnosis of GDM. METHODS: A case-control study of antenatal patients between 1 April and 30 June in 2019 and 2020 looking at detection rates of GDM, use of medication, obstetric, and fetal outcomes. RESULTS: During COVID-19, the rate of positive GDM tests approximately halved (20% (42/210) in 2020 vs. 42.2% (92/218) in 2019, (p < 0.01)) with higher rates of requirement for insulin at diagnosis (21.4% (2020) vs. 2.2% (2019); p < 0.01), and at term (31% (2020) vs. 5.4% (2019); p < 0.01). and metformin at diagnosis (4.8% (2020) vs. 1.1% (2019); p < 0.01), and at term (14.3% (2020) vs. 7.6% (2019) p < 0.01), with no differences in birth outcomes. CONCLUSIONS: There was likely an underdiagnosis of GDM while women at a higher risk of hyperglycaemia were correctly identified. The GTT should be maintained as the gold-standard test where possible, with provisions made for social distancing during testing if required.


Subject(s)
COVID-19 , Diabetes, Gestational , Case-Control Studies , Diabetes, Gestational/diagnosis , Diabetes, Gestational/epidemiology , Female , Glucose Tolerance Test , Humans , Pandemics , Pregnancy , Pregnancy Outcome/epidemiology , SARS-CoV-2
3.
BMJ Open Diabetes Res Care ; 9(2)2021 12.
Article in English | MEDLINE | ID: covidwho-1598547

ABSTRACT

INTRODUCTION: Early diagnosis of prediabetes based on blood sampling for the oral glucose tolerance test (OGTT) is crucial for intervention but multiple barriers hinder its uptake. This study aimed to assess the feasibility and precision of a self-administered capillary OGTT for type-2 diabetes mellitus (T2DM) in high-risk individuals. RESEARCH DESIGN AND METHODS: Participants with history of gestational diabetes or prediabetes were recruited in primary care. Due to their prediabetic status and previous diagnosis of gestational diabetes mellitus, a proportion of participants had previous experience doing OGTT. They self-administered the capillary OGTT and concurrently their venous glucose samples were obtained. They filled a questionnaire to collect their demographic information, views of their capillary OGTT, and their preferred site of the test. RESULTS: Among 30 participants enrolled in this feasibility study, 93.3% of them felt confident of performing the capillary OGTT themselves, and 70.0% preferred the test at home. Older, less educated participants found it less acceptable. Mean capillary glucose values were significantly higher than venous glucose values, with mean difference at 0.31 mmol/L (95% CI 0.13 to 0.49) at fasting, and 0.47 mmol/L (95% CI 0.12 to 0.92) 2 hours post-OGTT. Capillary and venous glucose measurements were correlated for fasting (r=0.95; p<0.001) and 2-hour-post-OGTT (r=0.95;p<0.001). The Fleiss-Kappa Score (0.79, p<0.0001) indicated fair agreement between the two methods. The capillary OGTT had excellent sensitivity (94.1%) and negative predictive value (NPV=91.7%) in identifying prediabetes or T2DM status, vis-a-vis to venous glucose samples. CONCLUSION: Self-administered capillary OGTT is feasible and acceptable, especially among younger adults, with excellent sensitivity and NPV compared with plasma-based OGTT.


Subject(s)
Diabetes, Gestational , Prediabetic State , Adult , Blood Glucose , Diabetes, Gestational/diagnosis , Feasibility Studies , Female , Glucose Tolerance Test , Humans , Prediabetic State/diagnosis , Pregnancy
4.
J Diabetes Res ; 2021: 5266919, 2021.
Article in English | MEDLINE | ID: covidwho-1546592

ABSTRACT

Gestational diabetes mellitus (GDM) is a serious and frequent pregnancy complication that can lead to short and long-term risks for both mother and fetus. Different health organizations proposed different algorithms for the screening, diagnosis, and management of GDM. Medical Nutrition Therapy (MNT), together with physical exercise and frequent self-monitoring, represents the milestone for GDM treatment in order to reduce maternal and fetal complications. The pregnant woman should benefit from her family support and make changes in their lifestyles, changes that, in the end, will be beneficial for the whole family. The aim of this manuscript is to review the literature about the Medical Nutrition Therapy in GDM and its crucial role in GDM management.


Subject(s)
Diabetes, Gestational/diet therapy , Diet, Healthy , Nutrition Therapy , Diabetes, Gestational/diagnosis , Diabetes, Gestational/physiopathology , Exercise , Female , Humans , Nutrition Therapy/adverse effects , Pregnancy , Protective Factors , Risk Assessment , Risk Factors , Risk Reduction Behavior , Treatment Outcome
5.
Acta Diabetol ; 59(3): 403-427, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1506064

ABSTRACT

AIMS: Gestational diabetes mellitus (GDM) diagnosed during the first trimester of pregnancy is called 'early pregnancy Gestational Diabetes Mellitus' (eGDM). The burden of eGDM has only been studied sporadically. This review aims to understand the global burden of eGDM in terms of prevalence, risk factors, pregnancy outcomes, treatment and postpartum dysglycemia.  METHODS: A review of epidemiologic studies reporting on early GDM screening as per Joanna Briggs Institute (JBI) methodology for prevalence reviews was conducted. A customized search strategy was used to search electronic databases namely, PubMed, CINAHL, EMBASE, Cochrane Library, Scopus, MEDLINE, Ovid, ScienceDirect, and Google Scholar. Three independent reviewers reviewed studies using Covidence software. Observational studies irrespective of study design and regardless of diagnostic criteria were included. Quality of evidence was appraised, and findings were synthesized. RESULTS: Of 58 included studies, 41 reported a prevalence of eGDM, ranging from 0.7 to 36.8%. Body mass index (BMI), previous history of GDM, family history of diabetes and multiparity were reported as eGDM risk factors. Adverse pregnancy outcomes associated with eGDM were macrosomia, caesarean delivery, induction of labour, hypertension, preterm delivery, and shoulder dystocia. The incidence of postpartum dysglycemia and the need for insulin was higher in women with eGDM. The risk of bias was moderate. Heterogeneity of studies is a limitation. Meta-analysis was not performed. CONCLUSIONS: There is heterogeneity in the prevalence of eGDM and intrapartum and postpartum ill effects for the mother and the offspring. There is a need to develop a universal screening protocol for eGDM.


Subject(s)
Diabetes, Gestational , Body Mass Index , Diabetes, Gestational/diagnosis , Diabetes, Gestational/epidemiology , Diabetes, Gestational/therapy , Female , Fetal Macrosomia , Humans , Infant, Newborn , Postpartum Period , Pregnancy , Pregnancy Outcome/epidemiology
6.
Prim Care Diabetes ; 16(1): 11-26, 2022 02.
Article in English | MEDLINE | ID: covidwho-1454409

ABSTRACT

BACKGROUND: Gestational diabetes is a disease with complex management that requires multidisciplinary collaboration. To achieve treatment goals, in addition to using medications and paying attention to exercise and diet, it is also important to take into account the mental health and psychosocial aspects of diabetes management. This study aimed to highlight these challenges associated with gestational diabetes. METHOD: This qualitative systematic review involved a search of the following databases: CINAHL, EMBASE, MEDLINE, and PsycINFO. Title, abstract, and full-text screening was done using Covidence software, and quality assessment of the included papers was conducted using the Critical Appraisal Skills Programme Checklist. Enhancing transparency in reporting the synthesis of the qualitative research statement (ENTREQ) was used in the design of this paper. Data synthesis was done using meta-aggregation method. RESULTS: Out of the 2440 articles searched, 24 were qualitatively analyzed. The CASP score of the included papers was optimal. The 514 findings extracted from the 24 studies were aggregated into five broad conceptual categories: psychological challenges, socio-cultural challenges, information-communication challenges, challenges associated with a lifestyle change, and challenges related to health care. CONCLUSION: Recognizing the psychosocial challenges associated with gestational diabetes and developing support packages tailored to psychosocial needs can help improve the management of these patients.


Subject(s)
Diabetes, Gestational , Communication , Diabetes, Gestational/diagnosis , Diabetes, Gestational/therapy , Exercise , Female , Humans , Life Style , Pregnancy , Qualitative Research
8.
Prim Care Diabetes ; 15(5): 887-889, 2021 10.
Article in English | MEDLINE | ID: covidwho-1336835

ABSTRACT

There is a lack of information about the maternal-fetal outcomes in patients with gestational diabetes and concomitant COVID-19; and there is even less information about the outcomes of pregnant women with gestational diabetes and COVID-19. We present a case of a primigravidae of 20-year-old woman with gestational diabetes and COVID-19 and a review of the literature.


Subject(s)
COVID-19 , Diabetes, Gestational , Pregnancy Complications, Infectious , Adult , Diabetes, Gestational/diagnosis , Diabetes, Gestational/therapy , Female , Humans , Pregnancy , Pregnancy Outcome , SARS-CoV-2 , Young Adult
9.
J Diabetes Investig ; 12(12): 2242-2246, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1329011

ABSTRACT

During the coronavirus disease 2019 pandemic, the Japanese Society of Diabetes and Pregnancy proposed the use of random plasma glucose and glycated hemoglobin measured 1 month after delivery combined with pre-pregnancy body mass index to detect postpartum glucose intolerance instead of carrying out the oral glucose tolerance test in women with gestational diabetes. We retrospectively evaluated the clinical utility of this strategy to detect postpartum glucose intolerance evaluated by the oral glucose tolerance test after delivery. A total of 275 Japanese women with gestational diabetes were included in the present study. The specificity of 1-month postpartum random plasma glucose and glycated hemoglobin combined with pre-pregnancy body mass index to predict postpartum glucose intolerance was 98.0%, with a negative predictive value of 72.6%. However, sensitivity was 6.4%, with a positive predictive value of 55.6%. In conclusion, this Japanese Society of Diabetes and Pregnancy strategy showed high specificity, but low sensitivity, for detecting glucose intolerance postpartum.


Subject(s)
Blood Glucose/metabolism , Body Mass Index , Diabetes, Gestational/blood , Glucose Intolerance/blood , Glycated Hemoglobin A/metabolism , Postpartum Period/blood , Adult , Diabetes, Gestational/diagnosis , Diabetes, Gestational/epidemiology , Female , Glucose Intolerance/diagnosis , Glucose Intolerance/epidemiology , Humans , Japan/epidemiology , Pregnancy , Retrospective Studies , Time Factors
10.
Int J Environ Res Public Health ; 18(4)2021 02 04.
Article in English | MEDLINE | ID: covidwho-1278488

ABSTRACT

Canada's largest national obstetric and diabetology organizations have recommended various algorithms for the screening of gestational diabetes mellitus (GDM) over the years. Though uniformity across recommendations from clinical practice guidelines (CPGs) is desirable, historically, national guidelines from Diabetes Canada (DC) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) have differed. Lack of consensus has led to variation in screening approaches, rendering precise ascertainment of GDM prevalence challenging. To highlight the reason and level of disparity in Canada, we conducted a scoping review of CPGs released by DC and the SOGC over the last thirty years and distributed a survey on screening practices among Canadian physicians. Earlier CPGs were based on expert opinion, leading to different recommendations from these organizations. However, as a result of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, disparities between DC and the SOGC no longer exist and many Canadian physicians have adopted their recent recommendations. Given that Canadian guidelines now recommend two different screening programs (one step vs. two step), lack of consensus on a single diagnostic threshold continues to exist, resulting in differing estimates of GDM prevalence. Our scoping review highlights these disparities and provides a step forward towards reaching a consensus on one unified threshold.


Subject(s)
Diabetes, Gestational , Hyperglycemia , Blood Glucose , Canada , Diabetes, Gestational/diagnosis , Diabetes, Gestational/epidemiology , Female , Humans , Mass Screening , Pregnancy , Pregnancy Outcome
11.
CMAJ ; 193(22): E813-E822, 2021 05 31.
Article in French | MEDLINE | ID: covidwho-1249582

ABSTRACT

CONTEXTE: La nature exacte des répercussions de la maladie à coronavirus 2019 (COVID-19) sur la santé maternelle et néonatale reste à préciser. Nous avons cherché à évaluer l'association entre l'infection par le coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) pendant la grossesse et les issues défavorables de la grossesse. MÉTHODES: Nous avons réalisé une revue systématique et une méta-analyse d'études observationnelles fournissant des données comparatives sur l'infection par le SRAS-CoV-2 et la gravité de la COVID-19 pendant la grossesse. Nous avons sélectionné les études admissibles à partir des bases de données MEDLINE, Embase, ClinicalTrials.gov, medRxiv et Cochrane au 29 janvier 2021, en utilisant les Medical Subject Headings (vedettes matière en médecine) et les expressions clés « severe acute respiratory syndrome coronavirus 2 OR SARS-CoV-2 OR coronavirus disease 2019 OR COVID-19 ¼ (coronavirus du syndrome respiratoire aigu sévère 2 ou SRAS-CoV-2 ou maladie à coronavirus 2019 ou COVID-19) AND « pregnancy ¼ (grossesse). Nous avons ensuite évalué la qualité méthodologique de toutes les études retenues avec l'échelle de Newcastle­Ottawa. Les issues primaires étaient la prééclampsie et la naissance prématurée. Les issues secondaires incluaient la mortinaissance et le diabète gestationnel, ainsi que d'autres issues de grossesse. Nous avons calculé des rapports de cotes (RC) sommaires ou des différences moyennes pondérées avec des intervalles de confiance (IC) à 95 % par méta-analyse à effets aléatoires. RÉSULTATS: Nous avons retenu 42 études portant sur 438 548 personnes enceintes. Comparativement à une absence d'infection par le SRAS-CoV-2 pendant la grossesse, le diagnostic de COVID-19 a été associé à la prééclampsie (RC 1,33; IC à 95 % 1,03­1,73), à la naissance prématurée (RC 1,82; IC à 95 % 1,38­2,39) et à la mortinaissance (RC 2,11; IC à 95 % 1,14­3,90). Par rapport à la COVID-19 légère, la COVID-19 grave était fortement associée à la prééclampsie (RC 4,16; IC à 95 % 1,55­11,15), à la naissance prématurée (RC 4,29; IC à 95 % 2,41­7,63), au diabète gestationnel (RC 1,99; IC à 95 % 1,09­3,64) et au faible poids à la naissance (RC 1,89; IC à 95 % 1,14­3,12). INTERPRÉTATION: La COVID-19 pourrait être associée à un risque accru de prééclampsie, de naissance prématurée et d'autres issues défavorables de la grossesse.


Subject(s)
COVID-19/complications , COVID-19/epidemiology , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Diabetes, Gestational/diagnosis , Diabetes, Gestational/virology , Female , Humans , Incidence , Infant, Low Birth Weight , Pre-Eclampsia/diagnosis , Pre-Eclampsia/virology , Pregnancy , Premature Birth/diagnosis , Premature Birth/virology , Severity of Illness Index , Stillbirth
12.
Nutr Metab Cardiovasc Dis ; 31(7): 2151-2155, 2021 06 30.
Article in English | MEDLINE | ID: covidwho-1246118

ABSTRACT

AIM: To discuss available information on the opportunity for pregnant women affected by diabetes/obesity to receive COVID-19 vaccine. DATA SYNTHESIS: Pregnant women with SARS-CoV-2 (COVID-19) infection are at high risk for severe acute respiratory syndrome and adverse outcomes. Pregnant women with severe COVID-19 present increased rates of preterm delivery (<37 gestational weeks), cesarean delivery and neonatal admissions to the intensive care unit. Comorbidity such as diabetes (pregestational or gestational) or obesity further increased maternal and fetal complications. It is known that diabetic or obese patients with COVID-19 present an unfavorable course and a worse prognosis, with a direct association between worse outcome and suboptimal glycol-metabolic control or body mass index (BMI) levels. Critical COVID-19 infection prevention is important for both mother and fetus. Vaccination during pregnancy is a common practice. Vaccines against COVID-19 are distributed across the world with some population considered to have a priority. Since pregnant women are excluded from clinical trials very little information are available on safety and efficacy of COVD-19 vaccines during pregnancy. However, it is well known the concept of passive immunization of the newborn obtained with transplacental passage of protective antibodies into the fetal/neonatal circulation after maternal infection or vaccination. Moreover, it has been reported that COVID-19 vaccine-induced IgG pass to the neonates through breastmilk. Therefore, maternal vaccination can protect mother, fetus and baby. CONCLUSIONS: After an individual risk/benefit evaluation pregnant and lactating women should be counselled to receive COVID-19 vaccines.


Subject(s)
Blood Glucose/metabolism , COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Diabetes, Gestational/blood , Lactation , Pregnancy Complications, Infectious/prevention & control , Pregnancy in Diabetics/blood , SARS-CoV-2/pathogenicity , Vaccination , Antibodies, Viral/blood , Biomarkers/blood , Body Mass Index , COVID-19/immunology , COVID-19/virology , COVID-19 Vaccines/adverse effects , Clinical Decision-Making , Diabetes, Gestational/diagnosis , Diabetes, Gestational/therapy , Female , Glycemic Control , Humans , Immunity, Maternally-Acquired , Maternal-Fetal Exchange , Milk, Human/immunology , Pregnancy , Pregnancy Complications, Infectious/blood , Pregnancy Complications, Infectious/immunology , Pregnancy Complications, Infectious/virology , Pregnancy in Diabetics/diagnosis , Pregnancy in Diabetics/therapy , Prenatal Care , Risk Assessment , Risk Factors , SARS-CoV-2/immunology , Vaccination/adverse effects
13.
J Diabetes Investig ; 12(11): 2104-2105, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1242169

ABSTRACT

The Japanese abnormal glucose tolerance before 24 gestational weeks diagnostic strategy in the evolving coronavirus disease 2019 pandemic published by the Japanese Society of Diabetes and Pregnancy.


Subject(s)
COVID-19/epidemiology , Diabetes Mellitus/diagnosis , Gestational Age , Glucose Intolerance/diagnosis , SARS-CoV-2 , Adult , Diabetes, Gestational/diagnosis , Female , Glycated Hemoglobin A/analysis , Humans , Japan/epidemiology , Pregnancy , Retrospective Studies
15.
J Diabetes Res ; 2021: 5537110, 2021.
Article in English | MEDLINE | ID: covidwho-1192132

ABSTRACT

This study was aimed at exploring the predictive value of first-trimester glycosylated hemoglobin (HbA1c) levels in the diagnosis of gestational diabetes mellitus (GDM). A total of 744 pregnant women registered at the Peking University International Hospital between March 2017 and March 2019 were included in this study. Data on personal characteristics and biochemical indicators of the pregnant women were collected during the first trimester. The International Association of Diabetes and Pregnancy Study Groups has adopted specific diagnostic criteria as the gold standard for the diagnosis of GDM. Receiver operating characteristic (ROC) curve statistics were used to assess the predictive value of first-trimester HbA1c levels in the diagnosis of GDM. HbA1c levels in the first trimester were significantly higher in the GDM group than in the non-GDM group (5.23% ± 0.29% vs. 5.06 ± 0.28%, P < 0.05). The first-trimester HbA1c level was an independent risk factor for gestational diabetes. The area under the ROC curve (AUC) of HbA1c for GDM was 0.655 (95% confidence interval 0.620-0.689, P < 0.001). The positive likelihood ratio was the highest at HbA1c = 5.9%, sensitivity was 2.78, and specificity was 99.83%. There was no statistical difference in AUC between fasting blood glucose and HbA1c (P = 0.407). First-trimester HbA1c levels can be used to predict GDM. The risk of GDM was significantly increased in pregnant women with first-trimester HbA1c levels > 5.9%. There was no statistical difference between first-trimester HbA1c and fasting blood glucose levels in predicting GDM.


Subject(s)
Diabetes, Gestational/diagnosis , Glycated Hemoglobin A/metabolism , Pregnancy Trimester, First/blood , Adult , Beijing , Biomarkers/blood , Blood Glucose/metabolism , Diabetes, Gestational/blood , Female , Humans , Longitudinal Studies , Predictive Value of Tests , Pregnancy , Prospective Studies , Risk Factors , Up-Regulation
16.
Medicina (Kaunas) ; 57(4)2021 Apr 15.
Article in English | MEDLINE | ID: covidwho-1187002

ABSTRACT

Gestational diabetes mellitus (GDM) is recognized as one of the most common medical complications of pregnancy that can lead to significant short-term and long-term risks for the mother and the fetus if not detected early and treated appropriately. Current evidence suggests that, with the use of appropriate screening programs for GDM, those women diagnosed and treated have reduced perinatal morbidity. It has been implied that, when screening for GDM, there should be uniformity in the testing used and in further management. This paper summarizes and compares current screening strategies proposed by international bodies and discusses application in the context of the COVID-19 pandemic.


Subject(s)
COVID-19 , Diabetes, Gestational , Diabetes, Gestational/diagnosis , Diabetes, Gestational/epidemiology , Female , Humans , Mass Screening , Pandemics , Pregnancy , SARS-CoV-2
18.
Nutr Metab Cardiovasc Dis ; 30(9): 1418-1422, 2020 08 28.
Article in English | MEDLINE | ID: covidwho-1121395

ABSTRACT

AIM: In response to the COVID-19 pandemic, there is a need for substantial changes in the procedures for accessing healthcare services. Even in the current pandemic, we should not reduce our attention towards the diagnosis and treatment of GDM. The purpose of this document is to provide a temporary guide for GDM screening, replacing the current guidelines when it is not possible to implement standard GDM screening because of an unfavorable risk/benefit ratio for pregnant women or when usual laboratory facilities are not available. DATA SYNTHESIS: At the first visit during pregnancy, we must exclude the presence of "Overt diabetes" in all women. The criteria for the diagnosis of overt diabetes are either fasting plasma glucose ≥126 mg/dL, or random plasma glucose ≥200 mg/dL, or glycated hemoglobin ≥6.5%. When the screening procedure (OGTT) cannot be safely performed, the diagnosis of GDM is acceptable if fasting plasma glucose is ≥ 92 mg/dL. In order to consider the impaired fasting glucose as an acceptable surrogate for the diagnosis of GDM, the fasting glucose measurement should be performed within the recommended time windows for the risk level (high or medium risk). CONCLUSIONS: The changes to the screening procedure for GDM reported below are specifically produced in response to the health emergency of the COVID-19 pandemic. Therefore, these recommended changes should cease to be in effect and should be replaced by current national guidelines when the healthcare authorities declare the end of this emergency.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Diabetes, Gestational/diagnosis , Pneumonia, Viral/epidemiology , Blood Glucose/analysis , COVID-19 , Female , Glucose Tolerance Test , Humans , Italy , Pandemics , Pregnancy , SARS-CoV-2
20.
BJOG ; 128(5): 917-920, 2021 04.
Article in English | MEDLINE | ID: covidwho-1119183

ABSTRACT

OBJECTIVE: To examine the differences in detection rate for gestational diabetes (GDM) comparing the methodology recommended by the National Institute for Health and Clinical Excellence (NICE) compared with testing described as appropriate during the Covid-19 pandemic by the Royal College of Obstetricians and Gynaecologists (RCOG). DESIGN: Cohort study of women delivering between 1 January 2016 and 1 July 2020. SETTING: London Teaching Hospital. POPULATION: All women delivering between 1 January 2016 and 13 May 2020 and follow up of women screening negative between 1 April 2020 and 13 May 2020. METHODS: Retrospective study of prospectively collected data. MAIN OUTCOME MEASURES: Detection rate of gestational diabetes. RESULTS: Using the RCOG guidance, the overall rate of women identified as having gestational diabetes fell from 7.7% (1853/24168) to 4.2% (35/831)(P = 0.0003). Of 230 women who tested negative according to the RCOG criteria from 1 April to 13 May but who subsequently had an oral glucose tolerance test, 47 (20.4%) were diagnosed as having gestational diabetes according to the NICE criteria. CONCLUSIONS: In our setting, the RCOG Covid-19 gestational diabetes screening regime failed to detect 47 of 82 (57%) women subsequently identified as gestational diabetics, and therefore cannot be recommended for general use. TWEETABLE ABSTRACT: Screening for GDM using RCOG Covid criteria reduced detection rates.


Subject(s)
COVID-19 , Diabetes, Gestational , Diagnostic Screening Programs , Mass Screening , Practice Guidelines as Topic/standards , Adult , Blood Glucose/analysis , COVID-19/epidemiology , COVID-19/prevention & control , Cohort Studies , Diabetes, Gestational/diagnosis , Diabetes, Gestational/epidemiology , Diagnostic Screening Programs/organization & administration , Diagnostic Screening Programs/standards , Female , Humans , Mass Screening/methods , Mass Screening/trends , Organizational Innovation , Pregnancy , Program Evaluation , Reproducibility of Results , SARS-CoV-2 , State Medicine/standards , United Kingdom/epidemiology
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