Italian recommendations for the diagnosis of gestational diabetes during COVID-19 pandemic: Position statement of the Italian Association of Clinical Diabetologists (AMD) and the Italian Diabetes Society (SID), diabetes, and pregnancy study group

Torlone, Elisabetta; Festa, Camilla; Formoso, Gloria; Scavini, Marina; Sculli, Maria Angela; Succurro, Elena; Sciacca, Laura; Bartolo, Paolo Di; Lapolla, Annunziata

doi:10.1016/j.numecd.2020.05.023

Cited by 17 publications

(26 citation statements)

References 3 publications

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“…To conclude, Italian recommendations [ 50 ] propose that if an OGTT cannot be safely performed, screening for GDM should be based on risk factors and the FPG value. Women with high risk factors should be tested at 16–18 weeks and an FPG ≥5.1 mmol/L is diagnosed as GDM.…”

Section: Resultsmentioning

confidence: 99%

Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence?

Raets

Beunen

Benhalima

2021

JCM

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The incidence of gestational diabetes mellitus (GDM) is increasing worldwide. This has a significant effect on the health of the mother and offspring. There is no doubt that screening for GDM between 24 and 28 weeks is important to reduce the risk of adverse pregnancy outcomes. However, there is no consensus about diagnosis and treatment of GDM in early pregnancy. In this narrative review on the current evidence on screening for GDM in early pregnancy, we included 37 cohort studies and eight randomized controlled trials (RCTs). Observational studies have shown that a high proportion (15–70%) of women with GDM can be detected early in pregnancy depending on the setting, criteria used and screening strategy. Data from observational studies on the potential benefit of screening and treatment of GDM in early pregnancy show conflicting results. In addition, there is substantial heterogeneity in age and BMI across the different study populations. Smaller RCTs could not show benefit but several large RCTs are ongoing. RCTs are also necessary to determine the appropriate cut-off for HbA1c in pregnancy as there is limited evidence showing that an HbA1c ≥6.5% has a low sensitivity to detect overt diabetes in early pregnancy.

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Section: Resultsmentioning

confidence: 99%

Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence?

Raets

Beunen

Benhalima

2021

JCM

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“… 116 Italian guidelines recommended that screening for GDM based on risk factors and FPG forms an acceptable alternative if screening with an OGGT cannot be safely performed. 117 A French study retrospectively applied in more than 4000 women the seven proposals of the Australian-New Zealand Societies to limit the number of OGTTs during the COVID-19 pandemic. 118 In their cohort, the option in which OGTTs would be performed in women without history of HIP and with FPG 4.7–5.0 mmol/L between 22 and 30 weeks of pregnancy, applying universal screening, was preferred.…”

Section: Overview Of the Included Publicationsmentioning

confidence: 99%

An Update on Screening Strategies for Gestational Diabetes Mellitus: A Narrative Review

Minschart¹,

Beunen²,

Benhalima³

2021

DMSO

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Gestational diabetes mellitus (GDM) is a frequent medical complication during pregnancy. Screening and diagnostic practices for GDM are inconsistent across the world. This narrative review includes data from 87 observational studies and randomized controlled trials (RCTs), and aims to give an overview of the current evidence on screening strategies and diagnostic criteria for GDM. Screening in early pregnancy remains controversial and studies show conflicting results on the benefit of screening and treatment of GDM in early pregnancy. Implementing the one-step "International Association of Diabetes and Pregnancy Study Groups" (IADPSG) screening strategy at 24-28 weeks often leads to a substantial increase in the prevalence of GDM, without conclusive evidence regarding the benefits on pregnancy outcomes compared to a two-step screening strategy with a glucose challenge test (GCT). In addition, RCTs are needed to investigate the impact of treatment of GDM diagnosed with IADPSG criteria on long-term maternal and childhood outcomes. Selective screening using a risk-factor-based approach could be helpful in simplifying the screening algorithm but carries the risk of missing significant proportions of GDM cases. A two-step screening method with a 50g GCT and subsequently a 75g oral glucose tolerance test (OGTT) with IADPSG could be an alternative to reduce the need for an OGTT. However, to have an acceptable sensitivity to screen for GDM with the IADPSG criteria, the threshold of the GCT should be lowered from 7.8 to 7.2 mmol/L. A pragmatic approach to screen for GDM can be implemented during the COVID-19 pandemic, using fasting plasma glucose (FPG), HbA1c or even random plasma glucose (RPG) to reduce the number of OGTTs needed. However, usual guidelines and care should be resumed as soon as the COVID pandemic is controlled.

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“…For diagnosis please refer to the document regarding GDM screening during COVID-19 pandemic [15]. Once obtained a Fig.…”

Section: Gestational Diabetesmentioning

confidence: 99%

“…For diagnosis please refer to the document regarding GDM screening during COVID-19 pandemic [15] . Once obtained a GDM diagnosis, the following tests are required if not available:…”

Section: Gestational Diabetesmentioning

confidence: 99%

Recommendations and management of hyperglycaemia in pregnancy during COVID-19 pandemic in Italy

Torlone

Sculli

Bonomo

et al. 2020

Diabetes Research and Clinical Practice

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Many specialists use the remote management of people with chronic disease as diabetes, but structured management protocols have not been developed yet. The COVID-19 pandemic has given a big boost to the use of telemedicine, as it allows to maintain the physical distance, essential to the containment of contagion having regular health contact. Encouraging results related to the use of telemedicine in women with hyperglycaemia in pregnancy, have been recently published. It is well known that hyperglycaemia alters the immune response to infections, that inflammation, in turn, worsens glycaemic control and that any form of hyperglycaemia in pregnancy (HIP) has effects not only on the mother but also on development of the foetus. Therefore, the Italian Diabetes and Pregnancy Study Group, together with a group of experts, developed these recommendations in order to guide physicians in the management of HIP, providing specific diagnostic, therapeutic

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Italian recommendations for the diagnosis of gestational diabetes during COVID-19 pandemic: Position statement of the Italian Association of Clinical Diabetologists (AMD) and the Italian Diabetes Society (SID), diabetes, and pregnancy study group

Cited by 17 publications

References 3 publications

Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence?

Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence?

An Update on Screening Strategies for Gestational Diabetes Mellitus: A Narrative Review

Recommendations and management of hyperglycaemia in pregnancy during COVID-19 pandemic in Italy

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