Testing for gestational diabetes during the COVID-19 pandemic. An evaluation of proposed protocols for the United Kingdom, Canada and Australia

Highlights • Guidelines for GDM diagnosis during COVID have changed. • Current guidelines are empirical and do not consider pregnancy outcomes. • Current guidelines all result in reduced detection of GDM cases. • Proposed Canadian guidelines reduce GDM by around 80%, but miss many complications. • Guidelines should consider both GDM frequency and complications detected or missed.
Aims We assessed how altered diagnostic processes and criteria for gestational diabetes mellitus (GDM) recommended by the United Kingdom (UK), Canada and Australia for use during the COVID-19 pandemic would affect both GDM frequency and related adverse outcomes. Methods Secondary analysis of 5974 HAPO study women with singleton pregnancies who underwent 75g OGTTs and HbA1c assays between 24 and 32 weeks’ gestation and who received no treatment for GDM. Results All post COVID-19 modified pathways reduced GDM frequency - UK (81%), Canada (82%) and Australia (25%). Canadian women whose GDM would remain undetected post COVID-19 (missed GDMs) displayed similar rates of pregnancy complications to those with post COVID-19 GDM. Using UK modifications, the missed GDM group were at slightly lower risk whilst the women missed using the Australian modifications were at substantially lower risk. Conclusions The modifications in GDM diagnosis proposed for the UK, Canada and Australia result in differing reductions of GDM frequency. Each has both potential benefits in terms of reduction in potential exposure to COVID-19 and costs in terms of missed opportunities to influence pregnancy and postpartum outcomes. These factors should be considered when deciding which protocol is most appropriate for a particular context.