Because of the 2019 novel coronavirus (COVID-19), clinicians are hesitant to recommend the oral glucose tolerance test (OGTT) to detect gestational diabetes mellitus (GDM). This is based on concerns regarding the risks/benefits of travel for in person testing.
In response to these concerns, medical societies from the United Kingdom, Canada, and Australia have released recommendations for modification of testing during the COVID-19 pandemic. All 3 emergency statements differ slightly in their recommendations, according to a report in Diabetes Care. The consensus of the recommendations is to reduce the need for OGTTs both during pregnancy and postpartum follow-up.
All guidelines support the use of an early pregnancy HbA1c ≥5.9% to identify women at risk of GDM. However, the UK is currently advocating for additional risk factor-based testing for GDM, including lowering the “at risk” HbA1c to ≥5.7%, and includes fasting venous plasma glucose (VPG) ≥5.6 mmol/L, or random VPG ≥9.0 mmol/L. Canada’s revised at-risk screening pathway includes HbA1c ≥ 5.7% and/or random VPG ≥11.1 mmol/L.
The revised Australian pathway does not include HbA1c cut off levels, but recommends a fasting VPG with progression to OGTT only if the result is between 4.7 to 5.0 mmol/L. The Australian guidelines also state that women with previous GDM should be considered to have GDM in the current pregnancy without testing and should be treated accordingly. The guide also states that postpartum follow-up testing should be delayed until either the pandemic has been controlled or another pregnancy is contemplated.
The authors noted that these guidelines are temporary and should only be used in the context of the COVID-19 pandemic. Both the UK and Canada have recommended all general antenatal care be conducted via telemedicine rather than face-to-face clinic visits whenever possible.
Of note, the International Federation of Gynecology and Obstetrics has recently published a global interim guidance on COVID-19 that states there is no current evidence to support that pregnant women are more susceptible to infection with severe acute respiratory virus 2 (SARS-CoV-2) or that those infected are more likely to develop severe disease.
“In this ‘new COVID world,’ GDM should not be ignored but pragmatically merits a lower priority than the avoidance of exposure to the COVID-19 virus,” the authors concluded.
McIntyre HD, Moses RG. The diagnosis and management of gestational diabetes mellitus in the context of the COVID-19 pandemic [published online May 14, 2020]. Diabetes Care. doi:10.2337/dci20-0026