(315) Comparative study of the alternative Gestational Diabetes Mellitus screening strategy utilized during the COVID-19 Pandemic

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: To minimize patient exposure to COVID-19 and limit healthcare utilization during the pandemic, the Society of Obstetricians and Gynaecologists of Canada and Diabetes Canada recommended a temporary alternative screening strategy for Gestational Diabetes Mellitus (GDM). Rather than the standard two-step approach using glucose challenge and oral glucose tolerance tests, the alternative strategy used a hemoglobin A1c and a random plasma glucose. The primary objective was to compare GDM diagnosis using the alternative screening strategy to the two-step approach, and secondarily to compare pharmacotherapy needs and perinatal outcomes.

Study Design: This retrospective population-based study was completed using data extracted from the Nova Scotia Atlee Perinatal Database. Two cohorts of singleton pregnancies were compared; those screened with the two-step approach prior to the pandemic and those screened with the alternative strategy. Rates of GDM diagnosis and need for pharmacotherapy were calculated, as well as the incidence of perinatal outcomes. Univariate and multivariate logistic regression analysis was performed to estimate predictors of GDM diagnosis.

Results: In total, 4521 births were included in the analysis; 2376 in the historical cohort and 2145 in the pandemic cohort. Diagnosis of GDM was decreased in the pandemic cohort (6.4 vs. 11.1%, p < 0.001). In contrast, the need for pharmacotherapy did not decrease despite the reduction in GDM diagnoses (4.1 vs. 3.8%, p = 0.65). The incidences of hypertensive disorders, large for gestational age, and cesarean birth were statistically higher in the pandemic cohort, whereas there was no difference in the incidences of shoulder dystocia, birth trauma, and neonatal hypoglycemia.

Conclusion: The temporary alternative GDM screening strategy may have aided in mitigating COVID-19 risk among the pregnant population; however, this approach led to under diagnosis of GDM and an increase in the incidence of some of the adverse perinatal outcomes traditionally associated with poor glycemic control.

Primary & Presenting Author(s)

Omar Albakri, FRCS, MBBS, RDMS
Maternal Fetal Medicine Specialist
Dalhousie University/ King Abdulaziz University
Jeddah, Makkah, Saudi Arabia

Coauthor(s)

JC
Jillian Coolen, FRCS, RDMS
Associate Professor & Maternal-Fetal Medicine Residency Program Director
Dalhousie University
Halifax, Canada, Canada
KM
Kara Matheson, MSc
Senior Biostatistician
Center for clinical research - QEII Hospital
Halifax, Canada, Canada