Managing Diabetes in Pregnancy Before, During, and After COVID-19

Diabetes Technol Ther. 2020 Jun;22(6):454-461. doi: 10.1089/dia.2020.0223. Epub 2020 May 18.

Abstract

Background: Pregnant women with diabetes are identified as being more vulnerable to the severe effects of COVID-19 and advised to stringently follow social distancing measures. Here, we review the management of diabetes in pregnancy before and during the lockdown. Methods: Majority of antenatal diabetes and obstetric visits are provided remotely, with pregnant women attending hospital clinics only for essential ultrasound scans and labor and delivery. Online resources for supporting women planning pregnancy and for self-management of pregnant women with type 1 diabetes (T1D) using intermittent or continuous glucose monitoring are provided. Retinal screening procedures, intrapartum care, and the varying impact of lockdown on maternal glycemic control are considered. Alternative screening procedures for diagnosing hyperglycemia during pregnancy and gestational diabetes mellitus (GDM) are discussed. Case histories describe the remote initiation of insulin pump therapy and automated insulin delivery in T1D pregnancy. Results: Initial feedback suggests that video consultations are well received and that the patient experiences for women requiring face-to-face visits are greatly improved. As the pandemic eases, formal evaluation of remote models of diabetes education and technology implementation, including women's views, will be important. Conclusions: Research and audit activities will resume and we will find new ways for supporting pregnant women with diabetes to choose their preferred glucose monitoring and insulin delivery.

Keywords: COVID-19; Closed-loop; Continuous glucose monitoring; Diabetes pregnancy; Gestational diabetes; Insulin pump therapy; Type 1diabetes; Type 2 diabetes.

MeSH terms

  • Adult
  • Betacoronavirus
  • Blood Glucose Self-Monitoring
  • COVID-19
  • Coronavirus Infections / complications
  • Coronavirus Infections / prevention & control*
  • Diabetes Mellitus, Type 1 / blood
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetes Mellitus, Type 1 / virology
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / virology
  • Diabetes, Gestational / blood
  • Diabetes, Gestational / drug therapy*
  • Diabetes, Gestational / virology
  • Female
  • Humans
  • Hypoglycemic Agents / administration & dosage
  • Insulin / administration & dosage
  • Insulin Infusion Systems
  • Pandemics / prevention & control*
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / prevention & control*
  • Pregnancy
  • Pregnancy Complications, Infectious / prevention & control*
  • Pregnancy Complications, Infectious / virology
  • Pregnancy in Diabetics / blood
  • Pregnancy in Diabetics / drug therapy*
  • Pregnancy in Diabetics / virology
  • Prenatal Care / methods*
  • SARS-CoV-2
  • Self-Management / methods
  • Telemedicine / methods*

Substances

  • Hypoglycemic Agents
  • Insulin