Maternal and infant outcomes in women with and without gestational diabetes mellitus in the COVID-19 era in China: Lessons learned

Abstract

AimsThe global COVID-19 pandemic has required a drastic transformation of prenatal care services. Whether the reformulation of the antenatal care systems affects maternal and infant outcomes remains unknown. Particularly, women with gestational diabetes mellitus (GDM) are among those who bear the greatest brunt. Thus, this study aimed to evaluate the impact of COVID-19 lockdown during late pregnancy on maternal and infant outcomes in women stratified by the GDM status in China.Study designThe participants were women who experienced the COVID-19 lockdown during late pregnancy (3185 in the 2020 cohort) or not (2540 in the 2019 cohort) that were derived from the Beijing Birth Cohort Study. Maternal metabolic indicators, neonatal outcomes, and infant anthropometrics at 12 months of age were compared between the two cohorts, stratified by the GDM status.ResultsParticipants who experienced COVID-19 lockdown in late pregnancy showed lower gestational weight gain than those in the control cohort. Nevertheless, they displayed a worse metabolic profile. COVID-19 lockdown during pregnancy was associated with higher glycosylated hemoglobin (HbA1c) (β= 0.11, 95% CI = 0.05–0.16, q-value = 0.002) and lower high density lipoprotein cholesterol level (HDL-C) level (β=–0.09, 95% CI = –0.14 to –0.04, q-value = 0.004) in women with GDM, adjusted for potential confounders. In normoglycemic women, COVID-19 lockdown in late pregnancy was associated with higher fasting glucose level (β= 0.10, 95% CI = 0.08–0.12, q-value <0.0001), lower HDL-C level (β=–0.07, 95% CI = –0.08 to –0.04, q-value <0.0001), and increased risk of pregnancy-induced hypertension (adjusted OR=1.80, 95%CI=1.30–2.50, q-value=0.001). The fasting glucose level decreased less from early to late pregnancy in women who experienced COVID-19 lockdown than in the controls, regardless of the GDM status. The HDL-C has risen less with COVID-19 lockdown in the normoglycemic subgroup. In contrast, no significant differences regarding neonatal outcomes or infant weight were found between the two cohorts.ConclusionExperiencing the COVID-19 lockdown in pregnancy was associated with worse maternal metabolic status but similar neonatal outcomes and infant weight.

Adverse perinatal outcomes in gestational diabetes mellitus with and without SARS-CoV-2 infection during pregnancy: results from two nationwide registries in Germany

“…Levels of fasting plasma glucose were higher in women with GDM and SARS-CoV-2 infection compared with those with GDM before the pandemic; the majority of the infected women were symptomatic with COVID-19-related symptoms. Similar results were recently published by others 31. In our study, for most women the SARS-CoV-2 infection was diagnosed with or shortly after GDM was confirmed.…”

Hospitalized COVID‐19 patients with diabetes have an increased risk for pneumonia, intensive care unit requirement, intubation, and death: A cross‐sectional cohort study in Mexico in 2020

“…[34][35][36] Diabetes has been linked to worse outcomes in COVID-19 patients in other studies. [37][38][39] This includes not only a higher risk of severe illness, but also complications from COVID-19. 40 examined with multivariate analysis, which revealed that diabetics with COVID-19 had a higher risk of death, ICU admission, and prolonged hospital stays.…”

“…In the wake of the COVID‐19 pandemic, Mexico has seen an increase in the number of diabetes cases 34‐36 . Diabetes has been linked to worse outcomes in COVID‐19 patients in other studies 37‐39 . This includes not only a higher risk of severe illness, but also complications from COVID‐19 40 .…”

“… 34 , 35 , 36 Diabetes has been linked to worse outcomes in COVID‐19 patients in other studies. 37 , 38 , 39 This includes not only a higher risk of severe illness, but also complications from COVID‐19. 40 Kumar et al conducted a meta‐analysis where out of 33 PubMed studies on COVID‐19 and diabetes, 90% of COVID‐19 patients with diabetes had an increased risk of death (OR: 1.90, CI: 1.37−2.64, p < 0.01).…”

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.…”