(CSEMP029) IMPACT OF COVID-19 ON POSTPARTUM GESTATIONAL DIABETES FOLLOW-UP AT HÔPITAL MAISONNEUVE-ROSEMONT

Abstract: IMPACT OF COVID-19 ON POSTPARTUM GESTATIONAL DIABETES FOLLOW-UP

Background:
In order to screen gestational diabetes patients with postpartum glucose abnormalities, it is recommended to perform a 75g oral glucose tolerance test (OGTT) between 6 weeks and 6 months following delivery.
The COVID-19 pandemic in March 2020 limited patient access to postpartum tests. In order to continue some form of screening, transiently prescribing glycated hemoglobin (HbA1c) and fasting blood glucose (FBG) tests three months postpartum was suggested. Our center then decided to provide HbA1c and FBG three months postpartum to improve postpartum screening when OGTT was unavailable. The aim of the present study is to evaluate if patients presented to the recommended screening and if postpartum prediabetes and diabetes where diagnosed adequately with the changed screening method.

Methods:
In this retrospective study, we reviewed the medical records of patients diagnosed with gestational diabetes. We analyzed follow-up tests up to one year postpartum, separated into 2 cohorts of patients who gave birth during the COVID-19 pandemic. The first group, from July 1, 2020, to January 1, 2021, used the OGTT as the main screening modality, compared to the second group, from March 1, 2021, to September 1, 2021, which used HbA1c and FBG as the main screening modality.

Results:
A total of 592 patient records were analyzed, with 284 in the first group and 308 in the second group. A screening test (either OGTT or HbA1c with FBG) was performed in 39.1% of cohort 1 compared to 46.8% in cohort 2. A positive test occurred in 10.2% of cohort 1 compared to 9.7% in the second group. 7% and 3.5% were diagnosed with prediabetes and diabetes, respectively, in group 1 compared to 7.5% and 3.2% in group 2. In the first cohort, 26.8% underwent a 75g OGTT, and in the second cohort, 38.3% underwent HbA1c and FBG, the favored tests for screening during the respective periods. These tests yielded a positive result in 7.7% of the first group when OGTT was used compared to 3.2% in the second group when HbA1c with FBG was used.

Conclusion:
The change in screening modality led to an increase in the number of patients undergoing screening tests. However, the lower sensitivity of HbA1c combined with FBG did not provide an advantage to this increase in screened patients.