Cardio-Metabolic and Mental Health Outcomes Before and During the COVID-19 Pandemic in a Cohort of Women With Gestational Diabetes Mellitus in Switzerland

Abstract

BackgroundThe COVID-19 pandemic has been associated with worsened metabolic and mental health in the general and perinatal population. The postpartum is a critical moment regarding these outcomes particularly in women with gestational diabetes mellitus (GDM). We investigated the cardio-metabolic and mental health outcomes before and during the pandemic in this population.MethodsThis cohort study included 418 women with GDM, recruited during two distinct periods. This included 180 women exposed to the pandemic (E+) and recruited between May 2020-April 2021 and 238 women who were not exposed to the pandemic during their postpartum period (attended a year before=non-exposed (E-)) and recruited between January-December 2019. Among the E+, a nested-subcohort of 120 women were exposed both during pregnancy and postpartum. During the pandemic, we adopted a hybrid follow-up of women that consisted of in-person consultations, regular contact via phone calls (35%), sent recorded exercise guide to patients to follow at home and linked to our website. We specifically focused on maintaining motivation and keeping a strong focus on healthy lifestyle behaviors. Obstetric, neonatal, cardio-metabolic and mental health outcomes were assessed during pregnancy and postpartum.ResultsThe pandemic was not associated with worsened weight, weight retention, glucose tolerance, metabolic syndrome, well-being or depression in the postpartum with the exception of a minimally increased HbA1c, diastolic blood pressure and lower emotional eating scores in E+ women (all p ≤ 0.046). In the nested subcohort, E+ women had a slightly increased HbA1c at the first GDM visit and a higher need for glucose-lowering medication (both p ≤ 0.014), but HbA1c at the end of pregnancy and other cardio-metabolic, mental health, obstetric and neonatal outcomes during pregnancy were similar.ConclusionsThe pandemic was not associated with any clinically relevant worsening of cardio-metabolic, mental health, obstetrical and neonatal outcomes in our GDM cohort. This was possibly due to a continued hybrid follow-up, and the partial lockdown in Switzerland.

COVID-19, Pregnancy, and Diabetes Mellitus

“…The possible increase in the prevalence of GDM during the pandemic may be due to several reasons, such as behavioral changes during lockdown, direct damage to pancreatic beta cells by the virus, or an infection-induced increase in insulin resistance. The following results can be derived from numerous studies on this question: ▪ GDM prevalence is increasing possibly associated with changes in screening procedures or lifestyle changes [57][58][59][60][61][62]; ▪ GDM prevalence does not change or is decreasing [63][64][65][66]; ▪ GDM is associated with a severe course of COVID-19 or insulin therapy [23,67]; ▪ Gestational weight gain (GWG) as a risk factor for GDM increases [68]. Taken together, from the existing literature there is some evidence that during the first two years of the pandemic and with low vaccination rate GDM prevalence increased locally, probably secondary to changes in lifestyle, such as less exercise, increasing BMI during lockdown, and GWG.…”