Diabetes Management Delivery and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus during the First Wave of the 2020 COVID-19 Pandemic: A Single-Reference Center Report
Magdalena Wilk, Paulina Surowiec, Bartłomiej Matejko, Albert Wróbel, Joanna Zięba-Parkitny, Katarzyna Cyganek, Hubert Huras, Maciej T. Małecki
Abstract
Objectives. The COVID-19 pandemic has forced a rapid adaptation of healthcare services to secure care for many patient groups. This includes women with gestational diabetes mellitus (GDM). We evaluated the impacts of the first COVID-19 wave on parameters such as the GDM treatment, glycemic control, and pregnancy outcomes. Methods. In this retrospective study from a reference diabetes center (Krakow, Poland), we compared patient data from two different time periods: the first wave of the COVID-19 pandemic (March 2020–June 2020) and the preceding five months (October 2019–February 2020). Data was collected from the medical records and telephone surveys. Results. We included 155 consecutive women (group <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mtext>N</a:mtext> <a:mn>1</a:mn> <a:mo>=</a:mo> <a:mn>73</a:mn> </a:math> and group <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mtext>N</c:mtext> <c:mn>2</c:mn> <c:mo>=</c:mo> <c:mn>82</c:mn> </c:math> from the COVID-19 pandemic period and non-COVID-19 period, respectively). During the COVID-19 pandemic, almost half of all GDM women ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mtext>N</e:mtext> <e:mn>1</e:mn> <e:mo>=</e:mo> <e:mn>36</e:mn> </e:math> , 49.3%) used telemedicine as a method of contacting their diabetic specialists while this tool was not utilized in the earlier period. Moreover, these patients reported difficulties in performing blood glucose self-control more often ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mtext>N</g:mtext> <g:mn>1</g:mn> <g:mo>=</g:mo> <g:mn>20</g:mn> </g:math> , 27.4%, vs <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mtext>N</i:mtext> <i:mn>2</i:mn> <i:mo>=</i:mo> <i:mn>7</i:mn> </i:math> , 8.5%; <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>p</k:mi> <k:mo>≤</k:mo> <k:mn>0.01</k:mn> </k:math> ) and spent less time on diabetes education than the control group on average ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mtext>N</m:mtext> <m:mn>1</m:mn> <m:mo>=</m:mo> <m:mn>39</m:mn> </m:math> , 53.4%, vs <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mtext>N</o:mtext> <o:mn>2</o:mn> <o:mo>=</o:mo> <o:mn>9</o:mn> </o:math> , 9.8% below 2 hours of training; <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mi>p</q:mi> <q:mo>≤</q:mo> <q:mn>0.01</q:mn> </q:math> ). Most analyzed glycemic parameters and pregnancy outcomes were similar. Differences were found with respect to the incidence of prolonged labor ( <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"> <s:mtext>N</s:mtext> <s:mn>1</s:mn> <s:mo>=</s:mo> <s:mn>12</s:mn> </s:math> , 16.4%, vs <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"> <u:mtext>N</u:mtext> <u:mn>2</u:mn> <u:mo>=</u:mo> <u:mn>3</u:mn> </u:math> , 3.7%; <w:math xmlns:w="http://www.w3.org/1998/Math/MathML" id="M12"> <w:mi>p</w:mi> <w:mo>≤</w:mo> <w:mn>0.01</w:mn> </w:math> ) and preeclampsia ( <y:math xmlns:y="http://www.w3.org/1998/Math/MathML" id="M13"> <y:mtext>N</y:mtext> <y:mn>1</y:mn> <y:mo>=</y:mo> <y:mn>0</y:mn> </y:math> vs <ab:math xmlns:ab="http://www.w3.org/1998/Math/MathML" id="M14"> <ab:mtext>N</ab:mtext> <ab:mn>2</ab:mn> <ab:mo>=</ab:mo> <ab:mn>7</ab:mn> </ab:math> , 8.5%; <cb:math xmlns:cb="http://www.w3.org/1998/Math/MathML" id="M15"> <cb:mi>p</cb:mi> <cb:mo>=</cb:mo> <cb:mn>0.01</cb:mn> </cb:math> ). Conclusion. In this single-center observational study, the first wave of the COVID-19 pandemic did not seem to have a negative impact on pregnancy outcomes in GDM women, despite the difficulties in diabetes management delivery.