Be pragmatic about testing, management of gestational diabetes during COVID-19
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Strategies for screening, diagnosis and management of gestational diabetes during the COVID-19 pandemic should incorporate alternative testing options and risk stratification in routine antenatal care.
“During this COVID-19 pandemic scenario, we need to ensure that women continue to receive their antenatal care in a safe manner, within health care environments with modified working conditions,” Shakila Thangaratinam, PhD, professor of maternal and perinatal health at the Institute of Metabolism and Systems Research at the University of Birmingham, U.K., told Healio. “Gestational diabetes is a high-risk condition, and our paper focuses on optimal ways to identify and manage mothers with gestational diabetes during a pandemic.”
Alternative testing
The routine use of an oral glucose tolerance test to screen for gestational diabetes must be “carefully considered” in the context of local pandemic impact, including community transmission rates, Thangaratinam and colleagues wrote; however, current evidence does not support a single, alternative test.
“We thus propose a strategy that utilizes alternative, simpler tests and mitigation ‘safety nets,’ balancing gestational diabetes detection with minimizing of health service burden and viral exposure of women,” the researchers wrote.
To minimize virus exposure for patients and staff, the researchers recommend clinicians measure HbA1c and random plasma glucose during the first antenatal visit to detect overt diabetes and identify women at highest risk for gestational diabetes. During local pandemic conditions, avoid using an OGTT at 24 to 28 weeks’ gestation; instead, offer HbA1c testing along with a fasting plasma glucose measurement, the researchers wrote. Women with past gestational diabetes should also be identified and monitored, and a personalized risk calculator should be applied for universal screening of gestational diabetes.
“We recommend that centers follow their current guidelines on whom to screen (selective or universal),” the researchers wrote. “For centers who currently use universal screening and feel this to be unsafe during the pandemic, we recommend using selective screening in conjunction with our proposed testing strategy. We have taken into account the following in providing suggestions for gestational diabetes screening in a pandemic: feasibility in an overstretched health care environment; minimizing travel, number of visits and duration of exposure for screening; characteristics of the screening tests.”
Postpartum screening
Similarly, the researchers wrote, postpartum OGTTs should be delayed until public health measures for control of the pandemic have been eased. More timely postpartum screening for persistent diabetes during the pandemic could be considered where there are significantly increased risk factors for type 1 or type 2 diabetes, or if a woman is planning an early subsequent pregnancy.
“In this setting an HbA1c at 3 to 6 months postpartum could be completed in the community,” the researchers wrote.
In an interview, Thangaratinam said pre-pandemic guidelines for gestational diabetes management should be followed “in all instances” when feasible.
“If not possible, we suggest clinicians follow pathways and alternate tests that minimize exposure of SARS-CoV-2 to the mother, without compromising her care,” Thangaratinam said. “The effect of COVID-19 on pregnant women with gestational diabetes, both directly from the disease and indirectly from changes in antenatal care pathways, need evaluation.”
For more information:
Shakila Thangaratinam, PhD, can be reached at the Institute of Metabolism and Systems Research, the University of Birmingham, IBR Tower, Level 2, College of Medical and Dental Sciences, Edgbaston, Birmingham, B15 2TT, United Kingdom; email: s.thangaratinam.1@bham.ac.uk; Twitter: @thangaratinam.
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