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Cited by 81Gestational Diabetes Research and ManagementCOVID-19 Impact on ReproductionDiabetes Management and Research

Testing for gestational diabetes during the COVID-19 pandemic. An evaluation of proposed protocols for the United Kingdom, Canada and Australia

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McIntyre, H. David, Gibbons, Kristen S., Ma, Ronald C.W., Tam, Wing Hung, Sacks, David A., Lowe, Julia, Madsen, Lene R., Catalano, Patrick M.·2020·Diabetes Research and Clinical Practice
DOI 10.1016/j.diabres.2020.108353PMC PMC7391984
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Abstract

AIMS: We assessed how altered diagnostic processes and criteria for gestational diabetes mellitus (GDM) recommended by the United Kingdom (UK), Canada and Australia for use during the COVID-19 pandemic would affect both GDM frequency and related adverse outcomes. METHODS: Secondary analysis of 5974 HAPO study women with singleton pregnancies who underwent 75 g OGTTs and HbA1c assays between 24 and 32 weeks' gestation and who received no treatment for GDM. RESULTS: All post COVID-19 modified pathways reduced GDM frequency - UK (81%), Canada (82%) and Australia (25%). Canadian women whose GDM would remain undetected post COVID-19 (missed GDMs) displayed similar rates of pregnancy complications to those with post COVID-19 GDM. Using UK modifications, the missed GDM group were at slightly lower risk whilst the women missed using the Australian modifications were at substantially lower risk. CONCLUSIONS: The modifications in GDM diagnosis proposed for the UK, Canada and Australia result in differing reductions of GDM frequency. Each has both potential benefits in terms of reduction in potential exposure to COVID-19 and costs in terms of missed opportunities to influence pregnancy and postpartum outcomes. These factors should be considered when deciding which protocol is most appropriate for a particular context.

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  • Simplifying the diagnosis of GDM in order to avoid the risk of COVID-19 infection was associated with the risk of not diagnosing GDM by as much as 20-30%.

    “However, simplifying the diagnosis of GDM in order to avoid the risk of COVID-19 infection was unfortunately associated with the risk of not diagnosing GDM by as much as 20–30%, which may affect obstetric outcomes [63,64,65].”

    From Gestational Diabetes Mellitus—Recent Literature Review (2022) · cites this paper as [65]

    The Discussion (page unavailable in our copy) says the proposed Australian protocol would reduce GDM diagnoses by 25%, within the claimed 20–30% range. But it also says the UK and Canadian approaches would each reduce diagnoses by over 80%, so 20–30% is not the maximum risk across the protocols evaluated. The Results and Discussion also report pregnancy complications among women whose GDM would be missed. (LLM, conf=0.90)

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  • A reanalysis of HAPO data demonstrated that women with FPG < 4.7 mmol/L had similar perinatal outcomes to women without gestational diabetes mellitus regardless of post-load values.

    “A reanalysis of HAPO data demonstrated that women with FPG < 4.7 mmol/L had similar perinatal outcomes to women without gestational diabetes mellitus regardless of post‐load values. 33”

    From Australasian Diabetes in Pregnancy Society ( <scp>ADIPS</scp> ) 2025 consensus recommendations for the screening, diagnosis and classification of gestational diabetes (2025) · cites this paper as [33]

    The Methods describe a reanalysis of HAPO data, and the Discussion (page unavailable) says the Australian protocol would miss some GDM cases whose complication risks appear lower. It also identifies 4.7 mmol/L as a testing threshold. The passages do not establish that women below that threshold had outcomes similar to women without GDM regardless of post-load values. (LLM, conf=0.82)

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Research works printed but not linked: 1

  1. [2]Yamamoto JM DL, Reig DS, Berger H. Urgent update - temporary alternative screening strategy for gestational diabetes screening furing the COVID-19 pandemic; 2020. https://els-jbs-prod-cdn.jbs.elsevierhealth.com/pb/assets/raw/Health%20Advance/journals/jcjd/JCJD_COVID_guidelines_020420-1585856697530.pdf [accessed 21 May 2020]. PMC8393494 35115249

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Authors
McIntyre, H. D., Gibbons, K. S., Ma, R. C. W., Tam, W. H., Sacks, D. A., Lowe, J., Madsen, L. R., & Catalano, P. M.
Affiliations
  • The University of Queensland (AU)
  • Chinese University of Hong Kong (HK)
  • Kaiser Permanente (US)
  • University of Newcastle Australia (AU)
  • Aarhus University Hospital (DK)
  • Tufts Medical Center (US)
ORCID
Venue
Diabetes Research and Clinical Practice
Publisher
Elsevier BV
Published
2020-09
Volume
167
Pages
108353
ISSN
0168-8227 (ISSN-L)
DOI
10.1016/j.diabres.2020.108353
PMC
PMC7391984
OpenAlex
W3045891690
Cited by
81
References
21
Citations by year
2026: 2 · 2025: 7 · 2024: 8 · 2023: 13 · 2022: 19 · 2021: 26 · 2020: 6
FWCI
9.79
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Research and Clinical Practice (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • NOVA (University of Newcastle Australia) (submittedVersion)
Funders
Steno Diabetes Center Aarhus
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Obstetrics and Gynecology › COVID-19 Impact on Reproduction
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
gestational diabetes mellitus, COVID-19 pandemic, diagnostic criteria, 75 g oral glucose tolerance test, HbA1c, missed diagnosis, HAPO study, pregnancy complications, postpartum outcomes, United Kingdom, Canada, Australia
MeSH terms
Betacoronavirus, Missed Diagnosis, COVID-19, SARS-CoV-2, Adult, Australia, Blood Glucose, Canada, Fasting, Female, Glucose Tolerance Test, United Kingdom, Glycated Hemoglobin, Humans, Pneumonia, Viral, Pregnancy, Pregnancy Complications, Infectious, Pregnancy Outcome, Pregnancy Trimester, Second, Pregnancy Trimester, Third, Diabetes, Gestational, Practice Guidelines as Topic, Coronavirus Infections, Pandemics

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