Diabetes mellitus, maternal adiposity, and insulin-dependent gestational diabetes are associated with COVID-19 in pregnancy: the INTERCOVID study

Abstract

Background Among non-pregnant individuals, diabetes mellitus (DM) and high body mass index (BMI) increase the risk of Covid-19 and its severity. Objective To determine whether DM and high BMI are risk factors for Covid-19 in pregnancy and whether gestational diabetes mellitus (GDM) is also associated with covid-19 diagnosis. Study Design INTERCOVID was a multinational study, conducted between March 2020 and February 2021 in 43 institutions from 18 countries, enrolling 2184 pregnant women ≥18 years; 2071 were included in these analyses. For each woman diagnosed with Covid-19, two non-diagnosed women delivering or initiating antenatal care at the same institution were also enrolled. Main exposures were pre-existing DM or high BMI (overweight/obesity defined as ≥25 kg/m 2 ), and GDM in pregnancy. Main outcome was a confirmed diagnosis of Covid-19 based on an RT-PCR test, antigen test, antibody test, radiological pulmonary findings, or ≥2 predefined Covid-19 symptoms at any time during pregnancy or delivery. Relationships of exposures and Covid-19 diagnosis were assessed using generalized linear models with a Poisson distribution and log link function, with robust standard errors to account for model misspecification. We also conducted sensitivity analyses: 1) restricted to those with an RT-PCR or antigen test in the last week of pregnancy; 2) restricted to those with an RT-PCR or antigen test during the entire pregnancy; 3) generating values for missing data using multiple imputation; and 4) analyses controlling for month of enrollment. In addition, among those who were diagnosed with Covid-19, we examined whether having GDM, DM, or high BMI, increased risk for having symptomatic vs. asymptomatic Covid-19. Results Covid-19 was associated with preexisting DM (RR=1.94, 95% CI=1.55, 2.42), overweight/obesity (RR=1.20; 95% CI=1.06, 1.37), and GDM (RR=1.21; 95% CI=0.99, 1.46). The GDM association was specifically among women requiring insulin, whether they were of normal-weight (RR=1.79, 95% CI=1.06, 3.01) or overweight/obese (RR=1.77, 95% CI=1.28, 2.45). A somewhat stronger association with Covid-19 diagnosis was observed among women with pre-existing DM, whether they were of normal weight (RR=1.93, 95% CI=1.18, 3.17) or overweight/obese (RR=2.32, 95% CI=1.82, 2.97). When the sample was restricted to those with a RT-PCR or antigen test in the week before delivery or during the entire pregnancy, including missing variables using imputation, or controlling for month of enrollment, the observed associations were comparable. Conclusion DM and overweight/obesity are risk factors for Covid-19 diagnosis in pregnancy, and insulin-dependent GDM is also associated with the disease. It is therefore essential that those women with these co-morbidities are vaccinated.

COVID-19 Pandemic and Its Impact on Perinatal Outcomes between Symptomatic and Asymptomatic Women

“…Expectedly, as demonstrated in some other studies, women with diabetes mellitus, hypertension, and respiratory disease carried a higher risk of symptomatic disease requiring longer hospitalization and longer recovery [ 13 , 17 ].…”

Gestational diabetes is associated with SARS-CoV-2 infection during pregnancy: A case-control study

“…A recently published multicentric study also reported an association between insulin dependent GDM and COVID-19 diagnosis in pregnancy, yet over 80% of the participants were SARS-CoV-2 positive at the time-point of delivery, thus chronologically after diagnosis of GDM [13] . Our report is to our knowledge the first case-control study providing evidence, even if limited, for a possible causal relationship between COVID-19 and onset of GDM.…”

Liver, NAFLD and COVID-19

“…Patients with NAFLD are generally prone to the development of infections [82]. This association is partially explained by the presence of relevant concomitant conditions in these patients, such as type 2 diabetes mellitus (T2DM) and obesity, which are both associated with an increased risk for COVID-19 [83][84][85][86][87][88][89]. Additionally, it may also be related to alterations in innate immunity or in gut microbiota [82].…”