Introduction: Gestational diabetes (GDM) is one of the most common complications in pregnancy, with a prevalence that continues to rise. At the time of the COVID-19 epidemic, immediate reorganisation and adjustment of the system was needed. Telemedicine support was offered in order to provide high-quality treatment to pregnant women. However, the success of the treatment is unknown. We therefore aimed to evaluate COVID-19 epidemic effects on pregnancy outcomes in GDM.
Methods: The maternal outcomes (insulin treatment, gestational weight gain, caesarean section, hypertensive disorders) and perinatal outcomes (rates of large and small for gestational age, preterm birth and a composite child outcome) of women visiting a university hospital diabetes clinic from March to December 2020 were compared with those treated in the same period in 2019.
Results: Women diagnosed with GDM during the COVID-19 epidemic (n=417), were diagnosed earlier (23.9 [11.7-26.0] vs. 25.1 [21.8-26.7] gestational week), had higher fasting glucose (5.2 [5.0-5.4] vs. 5.1 [4.8-5.3] mmol/l) and earlier pharmacological therapy initiation, and had achieved lower HbA1c by the end of followup (5.1% (32.2 mmol/mol) [4.9% (30.1 mmol/mol)-5.4% (35.0 mmol/mol)] vs. 5.2% (33.3 mmol/mol) [5.0% (31.1 mmol/mol) - 5.4%·(35.5 mmol/mol)], p<0.001) compared to a year before (n=430). No significant differences in perinatal outcomes were found.
Conclusions: Although GDM was diagnosed at an earlier gestational age and higher fasting glucose concentration was present at the time of diagnosis, the COVID-19 epidemic did not result in worse glucose control during pregnancy or worse pregnancy outcomes in Slovenia.
Uvod: Nosečnostna sladkorna bolezen (NSB) predstavlja enega od najpogostejših zapletov v nosečnosti. Incidenca v svetu in Sloveniji se povečuje ter predstavlja vse večje breme za zdravstveni sistem. V času epidemije COVID-19 je bilo treba nemudoma reorganizirati in prilagoditi obravnavo nosečnic v želji po zagotavljanju nemotene oskrbe in istočasno v luči zajezitve širjenja virusa. V Sloveniji je presejanje potekalo po standardnem postopku, standardno obravnavo pa je deloma nadomestilo telemedicinsko spremljanje. Doslej ni znano, v kolikšni meri je nekoliko prilagojen način obravnave v času epidemije vplival na uspešnost zdravljenja NSB, zato nas je zanimalo, kakšni so glikemični in perinatalni izidi zdravljenja žensk z NSB v času epidemije v primerjavi z enakim obdobjem leto poprej.
Metoda: Maternalne (zdravljenje z inzulinom, porast telesne mase med nosečnostjo, carski rez, hipertenzivne motnje) in perinatalne izide (rojstvo otrok, premajhnih ali prevelikih za gestacijsko starost, prezgodnje rojstvo, kompozit neonatalnih izidov, tj. hipoglikemija, zlatenica, distocija ramen mrtvorojenost, neonatalna smrt) žensk z NSB, ki so se zdravile v diabetološki ambulanti od marca do decembra 2020, smo primerjali z izidi žensk, zdravljenimi v enakem obdobju 2019.
Rezultati: V času epidemije COVID-19 (N = 419) je bila diagnoza NSB postavljena bolj zgodaj kot v enakem obdobju 2019 (N = 430) (gestacijska starost: 23,9 [11,7–26,0] vs. 25,1 [21,8–26,7]). Ob tem so imele ženske ob diagnozi višjo koncentracijo glukoze v krvi na tešče (5,2 [5,0–5,4] vs. 5,1 [4,8–5,3] mmol/l). V času epidemije COVID-19 so potrebovale zdravljenje z inzulinom bolj zgodaj in so v povprečju dosegle nižje vrednosti HbA1c ob prvem pregledu (5,1 % (32,2 mmol/mol) [4,9 (30,1 mmol/mol)–5,4 % (35,0 mmol/mol)] vs. 5,2 % (33,3 mmol/mol) [5,0 (31,1 mmol/mol)–5,4 % (35,5 mmol/mol)], p < 0,001). Pomembnih razlik v perinatalnih izidih nismo odkrili.
Sklepi: Kljub temu da je bila diagnoza NSB v času epidemije COVID-19 postavljena bolj zgodaj in so imele posameznice višje koncentracije glukoze na tešče ob diagnozi, pa rezultati ne kažejo slabše glikemične kontrole v času epidemije niti slabših perinatalnih izidov.
Keywords: COVID-19; LGA; early screening; gestational diabetes; perinatal outcomes; telemedicine.
© 2023 National Institute of Public Health, Slovenia, published by Sciendo.