The Diagnosis and Management of Gestational Diabetes Mellitus in the Context of the COVID-19 Pandemic
David McIntyre, Robert G. Moses
Abstract
The oral glucose tolerance test (OGTT) has, to date, been considered the cornerstone of the diagnosis of gestational diabetes mellitus (GDM). This is despite ongoing national and international disagreement regarding which women require testing, whether “one step” or “two step” testing is optimal, and which glucose thresholds should be used. However, in the context of the current coronavirus disease 2019 (COVID-19) pandemic, widespread anecdotal evidence suggests that both clinicians and pregnant women are increasingly unwilling to recommend or undergo the OGTT. This is based on valid concerns regarding travel, the possible need for two visits, and the time (up to 3 h) spent in the potentially infectious environment of specimen collection centers. Further, a GDM diagnosis generally involves additional health service visits for diabetes education, glucose monitoring review, and fetal ultrasonography, all of which carry exposure risks during a pandemic. In response to these concerns, professional societies from the U.K. (1), Canada (2), and Australia (3) have released urgent statements of advice/guidance for modification of GDM diagnostic pathways during the COVID-19 pandemic. Current GDM guidelines differ in each of these jurisdictions, as do the revised recommendations. All seek to reduce the need for OGTTs, both during pregnancy and in postpartum follow-up. All guidelines support use of an early pregnancy HbA1c ≥41 mmol/mol (5.9%) to identify GDM, though some offer other options. The revised recommendations for standard (24- to 28-week) GDM testing are more divergent. The U.K. currently advocates risk factor–based testing for GDM, and …