Gestational diabetes combined with overweight or obesity increases severe COVID-19 risk
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Pregnant women with gestational diabetes, combined with periconceptional overweight or obesity, had an increased risk for severe COVID-19, according to results of a prospective observational study.
This was especially prevalent among pregnant women who required insulin therapy, data from the COVID-19 Obstetric and Neonatal Outcome Study (CRONOS) showed.
“Most important for clinicians to know is that not only pre-existing diabetes, but also gestational diabetes is a risk factor for severe COVID-19, especially when it occurs in overweight individuals,” Ulrich Pecks, MD, a professor in the department of obstetrics and gynecology at the University Hospital Schleswig-Holstein in Kiel, Germany, told Healio. “Presumably, the severity of the diabetic metabolic condition also plays a role.”
While it is known that gestational diabetes mellitus (GDM) is a common pregnancy complication — global prevalence was 13.4% in 2021 — research on the association of GDM and maternal and neonatal pregnancy outcomes among pregnant women infected with SARS-CoV-2 are lacking.
Pecks and colleagues conducted an analysis of 1,490 women (mean age, 31 ± 5.2 years; 40.7% nulliparous) who had COVID-19 between April 3, 2020, and Aug. 24, 2021, none of whom were vaccinated, according to Pecks.
“A general recommendation for vaccination during pregnancy was not issued in Germany until September 2021 ... unfortunately, vaccination rates among pregnant women are still low at about 40%,” he said.
Maternal outcomes
Overall, results showed that GDM was not associated with adverse maternal outcomes (OR = 1.5; 95% CI, 0.88-2.57). However, women with overweight or obesity and GDM were at an increased risk for adverse maternal outcomes (adjusted OR = 2.69; 95% CI, 1.43-5.07). Women with GDM who had overweight or obesity and required insulin therapy were at an even greater risk for a severe course of COVID-19 (aOR = 3.05; 95% CI, 1.38-6.73).
“According to our analyses, BMI and a diabetic metabolic condition play the largest roles, ahead of maternal age and other pre-existing conditions such as asthma or hypertension,” Pecks said. “The only factor more important is the gestational week of infection. Women in the third trimester have a significantly higher risk of a severe course than women in the first trimester.”
Pecks mentioned that the virus variant does play a role.
“With omicron, we see much less severe courses than with the previous variants, but they sometimes occur, and we observe a positive effect from vaccination here as well,” he said. “It cannot be emphasized often enough how valuable vaccination is against COVID-19. I have seen and cared for several women suffering from COVID-19, all of them unvaccinated. The great fear of affected women who came into the clinic because of breathing difficulties was terrible.”
Neonatal outcomes
The analyses also showed that maternal GDM and maternal pre-conceptional overweight or obesity increased the risk for adverse fetal and neonatal outcomes (aOR = 1.83; 95% CI, 1.05-3.18). Regardless of GDM status, having overweight or obesity were influential factors in maternal (aOR = 1.87; 95% CI, 1.26-2.75) and neonatal outcomes (aOR = 1.81; 95% CI, 1.32-2.48) compared with having underweight or normal weight.
A vast majority of newborns experienced little to no effect from their mothers’ COVID-19 disease, Pecks noted.
“Here, we can fortunately reassure the affected women. However, there are secondary phenomena that can affect the newborn, such as premature birth due to COVID-19,” Pecks said. “We also confirm with our study that gestational diabetes mellitus is a serious risk for the pregnancy and the fetus, but fortunately can be easily recognized and treated.”
Perspective
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The paper by Pecks and colleagues reporting on the results of CRONOS reaffirms many of the known risk factors for more severe cases of COVID-19 and shows that — in combination — these risk factors can lead to more serious outcomes. We have known that pregnancy, obesity and diabetes individually contribute to more severe outcomes in COVID-19 patients.
Indeed, one of the first severe complications for pregnant women with COVID-19 that was noted was a presentation of a severe preeclampsia pattern. We certainly see preeclampsia more frequently in women with overweight and obesity who have GDM.
So, what shall we take away from this study? There is still a significant resistance among women who are contemplating pregnancy or are pregnant to receive COVID-19 vaccinations. Data like these reaffirm the potential consequences of COVID-19 in pregnancy, and we can explain these data to our patients to encourage vaccination. We can also use these data to encourage our patients with overweight or obesity to lose weight prepregnancy to minimize their risks, which can be particularly helpful to our patients who are still trying to wait out the pandemic before becoming pregnant.
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