Performance of Guidelines for the Screening and Diagnosis of Gestational Diabetes Mellitus During the COVID-19 Pandemic: A Scoping Review of the Guidelines and Diagnostic Studies Evaluating the Recommended Testing Strategies

Overview

Journal Diabet Epidemiol Manag

Specialty Endocrinology

Date 2022 Jan 24

PMID 35072134

Authors

Aisling M Curtis

Andrew J Farmer

Nia W Roberts

Laura C Armitage

Affiliations

Soon will be listed here.

Abstract

Aim: The COVID-19 pandemic has necessitated less resource-intensive testing guidelines to identify gestational diabetes mellitus (GDM). We performed a scoping review of the international evidence reporting the ability of diagnostic tests recommended during the pandemic to accurately identify patients with GDM, compared to pre-pandemic reference standards, and associated test and clinical outcomes.

Methods: A comprehensive search of the literature was carried out in Embase, LitCovid, Cochrane Covid-19 study register, and medRxiv on 14 June 2021.

Results: 145 unique citations were returned; after screening according to pre-specified inclusion criteria by title and abstract and then full text, 13 studies involving 40,836 pregnant people and an additional 52,884 instances of OGTT were included. Thresholds defined in the Australian pandemic guideline appear adequate to identify most GDM cases; false negative cases appeared at lower risk of hyperglycaemia-in-pregnancy(HIP)-related events. For UK and Canadian guidelines, a larger proportion would be misdiagnosed as non-GDM; these false negative cases had broadly equivalent HIP-related event rates as true positives.

Conclusions: The OGTT remains the most effective test to identify abnormal glucose processing in pregnancy, supporting the prompt return to standard guidelines post-pandemic. Cohort studies investigating the impact of the change in guidelines on GDM pregnancies and associated outcomes are needed.

Citing Articles

Assessing the impact of the COVID-19 pandemic on uptake and experiences of gestational diabetes mellitus screening in Ontario: A parallel convergent mixed-methods study.

Hadid D, Correia R, McDonald S, Darling E, Kirkwood D, Jones A PLoS One. 2024; 19(12):e0315983.

PMID: 39729523 PMC: 11676491. DOI: 10.1371/journal.pone.0315983.

References

Cosson E, Benbara A, Pharisien I, Nguyen M, Revaux A, Lormeau B . Diagnostic and prognostic performances over 9 years of a selective screening strategy for gestational diabetes mellitus in a cohort of 18,775 subjects. Diabetes Care. 2012; 36(3):598-603. PMC: 3579341. DOI: 10.2337/dc12-1428. View

Metzger B, Lowe L, Dyer A, Trimble E, Chaovarindr U, Coustan D . Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358(19):1991-2002. DOI: 10.1056/NEJMoa0707943. View

Tang Y, Lan X, Zhang Y, Zhou F, Cai C, Zhang J . [Anxiety and depression on gestational diabetes mellitus in early pregnancy]. Wei Sheng Yan Jiu. 2020; 49(2):179-184. DOI: 10.19813/j.cnki.weishengyanjiu.2020.02.002. View

Zhu S, Meehan T, Veerasingham M, Sivanesan K . COVID-19 pandemic gestational diabetes screening guidelines: A retrospective study in Australian women. Diabetes Metab Syndr. 2021; 15(1):391-395. DOI: 10.1016/j.dsx.2021.01.021. View

van-de-LIsle Y, Steer P, Watt Coote I, Cauldwell M . Impact of changes to national UK Guidance on testing for gestational diabetes screening during a pandemic: a single-centre observational study. BJOG. 2020; 128(5):917-920. DOI: 10.1111/1471-0528.16482. View

Nachtergaele C, Vicaut E, Bihan H, Pinto S, Sal M, Berkane N . HbA and fasting plasma glucose cannot replace oral glucose tolerance test in order to screen for hyperglycaemia in pregnancy. Diabet Med. 2021; 38(9):e14604. DOI: 10.1111/dme.14604. View

dEmden M, Ungerer J, de Jersey S . Alternative screening protocols may miss most cases of gestational diabetes mellitus during the COVID-19 pandemic. Med J Aust. 2021; 214(6):284-284.e1. PMC: 8250575. DOI: 10.5694/mja2.50974. View

McIntyre H, Jensen D, Jensen R, Kyhl H, Jensen T, Glintborg D . Gestational Diabetes Mellitus: Does One Size Fit All? A Challenge to Uniform Worldwide Diagnostic Thresholds. Diabetes Care. 2018; 41(7):1339-1342. DOI: 10.2337/dc17-2393. View

van Stralen K, Stel V, Reitsma J, Dekker F, Zoccali C, Jager K . Diagnostic methods I: sensitivity, specificity, and other measures of accuracy. Kidney Int. 2009; 75(12):1257-1263. DOI: 10.1038/ki.2009.92. View

10.

Vambergue A, Jacqueminet S, Lamotte M, Lamiche-Lorenzini F, Brunet C, Deruelle P . Three alternative ways to screen for hyperglycaemia in pregnancy during the COVID-19 pandemic. Diabetes Metab. 2020; 46(6):507-510. PMC: 7202320. DOI: 10.1016/j.diabet.2020.04.003. View

11.

Ikomi A, Mannan S, Simon G, Khan R, Smith S, Robbins J . Diagnosis of gestational diabetes during the pandemic: what is the risk of falling through the net?. Diabet Med. 2020; 37(10):1782-1784. PMC: 7362157. DOI: 10.1111/dme.14346. View

12.

Meek C, Murphy H, Simmons D . Random plasma glucose in early pregnancy is a better predictor of gestational diabetes diagnosis than maternal obesity. Diabetologia. 2015; 59(3):445-52. PMC: 4742503. DOI: 10.1007/s00125-015-3811-5. View

13.

Pillay J, Donovan L, Guitard S, Zakher B, Gates M, Gates A . Screening for Gestational Diabetes: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2021; 326(6):539-562. DOI: 10.1001/jama.2021.10404. View

14.

Meek C, Lindsay R, Scott E, Aiken C, Myers J, Reynolds R . Approaches to screening for hyperglycaemia in pregnant women during and after the COVID-19 pandemic. Diabet Med. 2020; 38(1):e14380. PMC: 7436759. DOI: 10.1111/dme.14380. View

15.

dEmden M, McLeod D, Ungerer J, Appleton C, Kanowski D . Development of a fasting blood glucose-based strategy to diagnose women with gestational diabetes mellitus at increased risk of adverse outcomes in a COVID-19 environment. PLoS One. 2020; 15(12):e0243192. PMC: 7714128. DOI: 10.1371/journal.pone.0243192. View

16.

Ekoe J, Goldenberg R, Katz P . Screening for Diabetes in Adults. Can J Diabetes. 2018; 42 Suppl 1:S16-S19. DOI: 10.1016/j.jcjd.2017.10.004. View

17.

Nachtergaele C, Vicaut E, Pinto S, Tatulashvili S, Bihan H, Sal M . COVID-19 pandemic: Can fasting plasma glucose and HbA1c replace the oral glucose tolerance test to screen for hyperglycaemia in pregnancy?. Diabetes Res Clin Pract. 2020; 172:108640. PMC: 7834431. DOI: 10.1016/j.diabres.2020.108640. View

18.

Cundy T, Ackermann E, Ryan E . Gestational diabetes: new criteria may triple the prevalence but effect on outcomes is unclear. BMJ. 2014; 348:g1567. DOI: 10.1136/bmj.g1567. View

19.

. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract. 2014; 103(3):341-63. DOI: 10.1016/j.diabres.2013.10.012. View

20.

Li M, Lan J, Liang J, Xiong X . Diagnostic accuracy of fasting plasma glucose as a screening test for gestational diabetes mellitus: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2020; 24(21):11172-11186. DOI: 10.26355/eurrev_202011_23605. View