Evaluation of the impact of the COVID-19 pandemic on gestational diabetes screening: DIABE-COVID Survey

Dear Editor,

Since the onset of the COVID-19 pandemic, pregnant women have been exposed to a higher risk of infection during health centre visits for reasons such as screening and/or diagnostic tests for gestational diabetes and its follow-up, if necessary. Prior to the COVID-19 pandemic, the Spanish Diabetes and Pregnancy Group (GEDE) (first page of Appendix 1) recommended two-stage screening, beginning with the O’Sullivan test (50 g of glucose) and followed by the 100-g oral glucose tolerance test if the O’Sullivan test was positive (≥140 mg/dl). However, during the COVID-19 pandemic and with a view to minimising pregnant women's risk of exposure during these tests, the GEDE, together with other scientific societies,^1,2 published (version 1.0 in March 2020,³ version 1.1 in April 2020⁴) updated specific recommendations.^5–7 These consisted of measuring HbA1c, basal plasma glucose or random plasma glucose if the usual diagnostic process could not be followed.

One year on, the GEDE sent out a survey to its members to assess the impact of the pandemic on gestational hyperglycaemia screening and diagnosis and whether any changes have been made in this regard.

This was a cross-sectional study in which all members of the GEDE were invited to take part. The GEDE has 31 members in total, both from the Spanish Diabetes Society [Sociedad Española de Diabetes, SED] as well as the Spanish Society of Gynaecology and Obstetrics [Sociedad Española de Ginecología y Obstetricia] and Family and Community Medicine [Sociedad Española de Medicina de Familia y Comunitaria], from several different autonomous communities (map by community) (Fig. 1). The group is a representation of gestational diabetes care provided in Spain (23 centres) and is made up of specialists in endocrinology and nutrition (18), obstetrics and gynaecology (12) and family and community medicine (1).

Figure 1.

A) Map by community. B) Centres with change of screening strategy in the first quarter. C) Centres with change of screening strategy in the second quarter. D) Centres with change of screening strategy in the third quarter.

An electronic survey was developed (Google Forms®); the survey consisted of 16 questions about screening and diagnosis before and during the pandemic (Appendix 2).

The survey was designed by three of the authors (MG, MM and MV), initially reviewed by a further three authors (IV, RC and MC) and finally by the remaining members of the GEDE.

The survey was sent to the group members email distribution list by the secretary of the SED.

Statistical analysis: a descriptive analysis of the answers obtained was performed. The data were expressed as n (%).

The survey revealed a change in the screening/diagnosis method in seven of the 22 participating centres in the first quarter (31.8%), in six centres in the second quarter (27.3%) and in eight centres in the third quarter (36.4%), with changes being made by the same centres in all three quarters. These centres were located in the communities of Andalusia, the Canary Islands, Catalonia, Madrid and the Basque Country.

The results of the survey show that the onset of the COVID-19 pandemic forced a substantial number of centres belonging to the GEDE group to change their gestational hyperglycaemia screening and diagnosis procedure, reflecting the different realities experienced by each centre according to the epidemiological data.

Finding a balance between preventing the spread of COVID-19 and reducing the clinical risk of gestational hyperglycaemia is not easy to achieve. Recent recommendations promote diagnostic approaches that limit exposure in blood draws but result in more cases of undiagnosed gestational hyperglycaemia, which could potentially increase the risk of adverse pregnancy outcomes.

Options should be weighed up based on the epidemiological situation at each centre and progressively adapted as the pandemic progresses.

The gestational hyperglycaemia screening and diagnosis survey administered to GEDE members shows that 22%–27% of the centres (between six and eight out of 22 centres, depending on the quarter) adapted their procedures due to the COVID-19 pandemic in the autonomous communities where the epidemiological situation was most severe.

The complete survey can be viewed at: https://www.sediabetes.org/grupos_de_trabajo/diabetesy-embarazo/