Clinicians' perspectives on gestational diabetes screening during the global COVID-19 pandemic in Australia

Nina Meloncelli; Emma Shipton; Jenny Doust; Michael D'Emden; Harold David McIntyre; Leonie Callaway; Susan de Jersey

doi:10.1111/ajo.13601

Clinicians' perspectives on gestational diabetes screening during the global COVID-19 pandemic in Australia

Aust N Z J Obstet Gynaecol. 2022 Aug 12:10.1111/ajo.13601. doi: 10.1111/ajo.13601. Online ahead of print.

Authors

Nina Meloncelli¹, Emma Shipton², Jenny Doust³, Michael D'Emden⁴, Harold David McIntyre⁵, Leonie Callaway^{1

2}, Susan de Jersey^{1

6}

Affiliations

¹ Faculty of Medicine, Centre for Clinical Research and Perinatal Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
² Women's and Newborn Services Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.
³ Faculty of Medicine, Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
⁴ Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
⁵ Mater Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
⁶ Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.

Abstract

Aim: There is no international consensus for the screening and diagnosis of gestational diabetes mellitus (GDM). In March 2020, modified screening and diagnostic recommendations were rapidly implemented in Queensland, Australia, in response to the COVID-19 pandemic. How clinicians perceived and used these changes can provide insights to support high-quality clinical practice and provide lessons for future policy changes. The aim of this study was to understand clinicians' perceptions and use of COVID-19 changes to GDM screening and diagnostic recommendations.

Methods: Queensland healthcare professionals responsible for diagnosing or caring for women with GDM were recruited for semi-structured telephone interviews. Data analysis of transcribed interviews used inductive reflexive thematic analysis.

Results: Seventeen interviews were conducted with the following participants: six midwives/nurses, three endocrinologists, two general practitioners, two general practitioners/obstetricians, two diabetes educators, one dietitian and one obstetrician. Three themes emerged: communication and implementation, perceptions and value of evidence and diversity in perceptions of GDM screening. Overall, clinicians welcomed the rapid changes during the initial uncertainty of the pandemic, but as COVID-19 became less of a threat to the Queensland healthcare system, some questioned the underlying evidence base. In areas where GDM was more prevalent, clinicians more frequently worried about missed diagnoses, whereas others who felt that overdiagnosis had occurred in the past continued to support the changes.

Conclusions: These findings highlight the challenges to changing policy when clinicians have diverse (and often strongly held) views.

Keywords: COVID-19; SARS-CoV-2; gestational diabetes mellitus; health care professional; maternity.

© 2022 Commonwealth of Australia. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Abstract

Grants and funding