Association of COVID-19 Lockdown With Gestational Diabetes Mellitus

Abstract

ImportanceThe ongoing pandemic of COVID-19 is still affecting our life, but the effects of lockdown measures on gestational diabetes mellitus (GDM) in pregnant women remain unclear.AimTo investigate the association between COVID-19 lockdown and GDM.Subjects and MethodsMedical records of 140844 pregnant women during 2015-2020 were extracted from 5 hospitals in Guangdong Province, China. Pregnant women who underwent the COVID-19 Level I lockdown (1/23 - 2/24/2020) during pregnancy were defined as the exposed group (N=20472) and pregnant women who underwent the same calendar months during 2015-2019 (1/23 - 2/24) were defined as the unexposed group (N=120372). Subgroup analyses were used to explore the potential susceptible exposure window of COVID-19 lockdown on GDM. Cumulative exposure is quantitatively estimated by assigning different weights to response periods with different exposure intensities. A logistic regression model was used to estimate the association between COVID-19 lockdown exposure and GDM.ResultsThe rates of GDM in the exposed and unexposed groups were 15.2% and 12.4%, respectively. The overall analyses showed positive associations (odds ratio, OR=1.22, 95%CI: 1.17, 1.27) between lockdown exposure and GDM risk in all pregnant women. More pronounced associations were found in women who underwent the COVID-19 lockdown in their first four months of pregnancy, and the adjusted OR values ranged from 1.24 (95%CI: 1.10, 1.39) in women with 5-8 gestational weeks (GWs) to 1.35 (95%CI: 1.20, 1.52) with < 5 GWs. In addition, we found a positive exposure-response association of cumulative lockdown exposure with the risk of GDM.ConclusionsThe COVID-19 lockdown was associated with an increased risk of GDM, and the first four months of pregnancy may be the window for sensitive exposure.

Gestational diabetes mellitus in the COVID‐19 pandemic: A retrospective study from Hangzhou, China

“… 14 Studies from China also suggest that the COVID‐19 pandemic may increase the risk of GDM. 16 , 19 However, our findings indicate that the short‐ and long‐term effects of the COVID‐19 pandemic on the prevalence of GDM may not be consistent. During the most severe period of the COVID‐19 pandemic, the prevalence of GDM was higher only in January and March 2020 than in the same period of 2019 before the COVID‐19 outbreak.…”

“…During a Level 1 response, some public places are temporarily closed, such as shopping centers and bars; social events and gatherings for residents are restricted. 16 During the Level 3 response, public places take routine preventive measures such as wearing masks, taking body temperature, and maintaining social distancing. As a result, life gradually returns to what it was before the COVID‐19 pandemic.…”

“…The confinement measures taken in response to the COVID‐19 pandemic had a negative impact on pregnant women, for example, with a significantly higher incidence of GDM 14,15 . Similarly, a recent study from Guangdong, China, found that the COVID‐19 pandemic increased the prevalence of GDM (15.2% vs. 12.4%) 16 . Moreover, the COVID‐19 pandemic has worsened postprandial glycemic control in patients with GDM, leading to an increase in the proportion of pregnant women requiring insulin 17 …”

“…18 Current studies have focused on the short‐term changes of the COVID‐19 pandemic lockdown period on the prevalence of GDM. 14 , 16 , 17 , 19 However, no study has examined differences in the prevalence of GDM after control of the COVID‐19 pandemic and the risk of pregnancy outcomes in pregnant women diagnosed with GDM during the pandemic blockade. Therefore, this study sought to investigate the changes of the COVID‐19 pandemic and postpandemic era on the prevalence of GDM and the risk of adverse pregnancy outcomes of pregnant women diagnosed with GDM during the lockdown period of the COVID‐19 pandemic.…”

“…China controlled the spread of the epidemic as early as April 2020 and entered a “dynamic COVID‐zero” period 18 . Current studies have focused on the short‐term changes of the COVID‐19 pandemic lockdown period on the prevalence of GDM 14,16,17,19 . However, no study has examined differences in the prevalence of GDM after control of the COVID‐19 pandemic and the risk of pregnancy outcomes in pregnant women diagnosed with GDM during the pandemic blockade.…”