Gestational diabetes mellitus screening in pandemic times: Are there viable alternatives?

Rocha, Alexandre da Silva; Bernardi, Juliana Rombaldi; Matos, Salete de; Kretzer, Daniela Cortés; Schöffel, Alice Carvalhal; Moretti, Felipe; Magalhães, José Antônio de Azevedo

doi:10.1111/ajo.13235

Cited by 3 publications

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“…Nevertheless, their conclusions that where universal screening was conducted, COVID‐19 infection was often asymptomatic, and severe and critical disease rates among pregnant and birthing women approximated those in the general population, were reassuring to clinicians faced with providing safe care to women during the ongoing pandemic. Also in October, we published three items dealing with the urgent topic of providing optimal screening for gestational diabetes during the pandemic, while keeping women and caregivers safe 6–8 . In the current issue we are pleased to publish the most recent recommendations from the National COVID‐19 Clinical Evidence Taskforce.…”

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“…Also in October, we published three items dealing with the urgent topic of providing optimal screening for gestational diabetes during the pandemic, while keeping women and caregivers safe. [6][7][8] In the current issue we are pleased to publish the most recent recommendations from the National COVID-19 Clinical Evidence Taskforce. 9 Also in this issue, we present a thoughtful opinion piece on the effects of the pandemic on our specialist trainees, in Australia and the region.…”

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ANZJOG IN 2020 – the past, the present, and the future

Costa

2020

Aust NZ J Obst Gynaeco

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ANZJOG turned 60 during 2020 -but it was not the year we were expecting in January, when COVID-19 made a distant appearance in the Chinese city of Wuhan. In February 'the coronavirus' was still an overseas phenomenon, something unlikely to impact Australia and Australians much at all. By the beginning of March we were scrambling to obtain swabs and masks, and the terms 'social distancing' and 'personal protective equipment', PPE, were becoming familiar to us. By the end of that month, much of the population was restricted in their homes, businesses were shutting, citizens were rapidly returning from overseas, quarantining appeared, and the new normal, including strict lockdowns in Melbourne, is still with us as I write.

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ANZJOG IN 2020 – the past, the present, and the future

Costa

2020

Aust NZ J Obst Gynaeco

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Telemedical Approaches to Managing Gestational Diabetes Mellitus During COVID-19: Systematic Review

Eberle¹,

Stichling²

2021

JMIR Pediatr Parent

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Background In 2019, a new coronavirus emerged in China, and the disease caused by the virus (COVID-19) was rapidly classified as a pandemic. Pregnant women with gestational diabetes mellitus (GDM) are considered to be at risk for severe COVID-19. In the context of the pandemic, there are serious concerns regarding adverse effects on maternal and neonatal outcomes for women with GDM. Effective treatments for patients with GDM are therefore particularly important. Due to contact restrictions and infection risks, digital approaches such as telemedicine are suitable alternatives. Objective This systematic review aims to summarize currently available evidence on maternal and offspring outcomes of pregnant women with GDM and COVID-19 and to examine telemedical interventions to improve maternal glycemic control during the COVID-19 pandemic. Methods Publications were systematically identified by searching the Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, Embase, and CINAHL databases for studies published up to March 2021. We sorted the COVID-19 studies by outcome and divided the telemedical intervention studies into web-based and app-based groups. We analyzed case reports (COVID-19) and both randomized and nonrandomized controlled clinical trials (telemedicine). To determine the change in glycated hemoglobin A1c (HbA1c), we pooled appropriate studies and calculated the differences in means, with 95% CIs, for the intervention and control groups at the end of the interventions. Results Regarding COVID-19 studies, we identified 11 case reports, 3 letters, 1 case series, and 1 retrospective single-center study. In total, 41 patients with GDM and COVID-19 were analyzed. The maternal and neonatal outcomes were extremely heterogeneous. We identified adverse outcomes for mother and child through the interaction of GDM and COVID-19, such as cesarean deliveries and low Apgar scores. Furthermore, we selected 9 telemedicine-related articles: 6 were randomized controlled trials, 2 were clinical controlled trials, and 1 was a quasi-experimental design. In total, we analyzed 480 patients with GDM in the intervention groups and 494 in the control groups. Regarding the quality of the 9 telemedical studies, 4 were rated as strong, 4 as moderate, and 1 as weak. Telemedical interventions can contribute to favorable impacts on HbA1c and fasting blood glucose values in the context of the COVID-19 pandemic. Meta-analysis revealed a mean difference in HbA1c of –0.19% (95% CI 0.34% to 0.03%) for all telemedical interventions, –0.138% (95% CI –0.24% to –0.04%) for the web-based interventions, and –0.305% (96% CI –0.88% to 0.27%) for the app-based interventions. Conclusions Telemedicine is an effective approach in the context of COVID-19 and GDM because it enables social distancing and represents optimal care of patients with GDM, especially with regard to glycemic control, which is very important in view of the identified adverse maternal and neonatal outcomes. Further research is needed.

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Telemedical Approaches to Managing Gestational Diabetes Mellitus During COVID-19: Systematic Review (Preprint)

Eberle¹,

Stichling²

2021

Preprint

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BACKGROUND In 2019, a new coronavirus emerged in China, and the disease caused by the virus (COVID-19) was rapidly classified as a pandemic. Pregnant women with gestational diabetes mellitus (GDM) are considered to be at risk for severe COVID-19. In the context of the pandemic, there are serious concerns regarding adverse effects on maternal and neonatal outcomes for women with GDM. Effective treatments for patients with GDM are therefore particularly important. Due to contact restrictions and infection risks, digital approaches such as telemedicine are suitable alternatives. OBJECTIVE This systematic review aims to summarize currently available evidence on maternal and offspring outcomes of pregnant women with GDM and COVID-19 and to examine telemedical interventions to improve maternal glycemic control during the COVID-19 pandemic. METHODS Publications were systematically identified by searching the Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, Embase, and CINAHL databases for studies published up to March 2021. We sorted the COVID-19 studies by outcome and divided the telemedical intervention studies into web-based and app-based groups. We analyzed case reports (COVID-19) and both randomized and nonrandomized controlled clinical trials (telemedicine). To determine the change in glycated hemoglobin A1c (HbA1c), we pooled appropriate studies and calculated the differences in means, with 95% CIs, for the intervention and control groups at the end of the interventions. RESULTS Regarding COVID-19 studies, we identified 11 case reports, 3 letters, 1 case series, and 1 retrospective single-center study. In total, 41 patients with GDM and COVID-19 were analyzed. The maternal and neonatal outcomes were extremely heterogeneous. We identified adverse outcomes for mother and child through the interaction of GDM and COVID-19, such as cesarean deliveries and low Apgar scores. Furthermore, we selected 9 telemedicine-related articles: 6 were randomized controlled trials, 2 were clinical controlled trials, and 1 was a quasi-experimental design. In total, we analyzed 480 patients with GDM in the intervention groups and 494 in the control groups. Regarding the quality of the 9 telemedical studies, 4 were rated as strong, 4 as moderate, and 1 as weak. Telemedical interventions can contribute to favorable impacts on HbA1c and fasting blood glucose values in the context of the COVID-19 pandemic. Meta-analysis revealed a mean difference in HbA1c of –0.19% (95% CI 0.34% to 0.03%) for all telemedical interventions, –0.138% (95% CI –0.24% to –0.04%) for the web-based interventions, and –0.305% (96% CI –0.88% to 0.27%) for the app-based interventions. CONCLUSIONS Telemedicine is an effective approach in the context of COVID-19 and GDM because it enables social distancing and represents optimal care of patients with GDM, especially with regard to glycemic control, which is very important in view of the identified adverse maternal and neonatal outcomes. Further research is needed.

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Gestational diabetes mellitus screening in pandemic times: Are there viable alternatives?

Cited by 3 publications

References 3 publications

ANZJOG IN 2020 – the past, the present, and the future

ANZJOG IN 2020 – the past, the present, and the future

Telemedical Approaches to Managing Gestational Diabetes Mellitus During COVID-19: Systematic Review

Telemedical Approaches to Managing Gestational Diabetes Mellitus During COVID-19: Systematic Review (Preprint)

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