Should we screen with a fasting blood glucose? A modified screening strategy during the COVD-19 pandemic for gestational diabetes – a large tertiary comparative cohort study — ASN Events
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  2. Session 3: Antenatal and Technology
  3. Should we screen with a fasting blood glucose? A modified screening strategy during the COVD-19 pandemic for gestational diabetes – a large tertiary comparative cohort study

Should we screen with a fasting blood glucose? A modified screening strategy during the COVD-19 pandemic for gestational diabetes – a large tertiary comparative cohort study (#15)

Jessica Deitch 1 2 , Paul Lawton 1 , I-Lynn Lee 1 2 , Christopher J Yates 1 2 , Esha Kathpal 1 , Ibrahim Shahid 1 , Bailey Vickers 1 , Cheryl E Steele 1 , Shane Hamblin 1 2 , Bala Krishnamurthy 1 , Joanne M Said 3 4 5 , Glyn Teale 3 , Dev Kevat 1 2 6
  1. Department of Diabetes and Endocrinology, Western Health, St Albans, Victoria, Australia
  2. Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
  3. Department of Obstetrics and Gynaecology, Western Health, St Albans, Victoria, Australia
  4. Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
  5. Department of Maternal Foetal Medicine, Western Health, St Albans, Victoria, Australia
  6. Department of Obstetric Medicine, Western Health, St Albans, Victoria, Australia

Background:

The diagnosis of gestational diabetes mellitus (GDM) is both resource intensive and contentious. During the COVID-19 pandemic, a modified screening strategy was implemented at Western Health, Melbourne, a large tertiary centre catering to a multi-ethnic population severely affected by COVID-19 with a GDM prevalence of 20-23%. In place of a universal 2-hour 75g oral glucose tolerance test (OGTT) to reduce viral transmission time, a novel two-step diagnostic approach with fasting blood glucose (FBG) followed by an OGTT was implemented depending on FBG thresholds. A FBG >5.0 mmol/L diagnosed GDM while those with a FBG 4.7-5.0 mmol/L proceeded to an OGTT. Those with a FBG <4.7 mmol/L did not receive further testing, excluding GDM.

 

Methods:

A retrospective cohort study compared maternal and neonatal outcomes of singleton pregnancies birthing after 20 weeks’ gestation, with 6469 women undergoing modified screening (MS) during the COVID-19 pandemic from January 1st 2021 until 31st December 2021, and 8669 women having conventional screening (CS) prior to the pandemic from 1st January 2019 until 30th June 2020.

 

Results:

GDM prevalence was comparable using either MS or CS (MS vs CS, 22.9 vs 22.2%, p=0.310). Obesity rates were also similar (27.8 vs 27.2%, p=0.308).  There was no difference in the rate of large for gestational age (LGA) infants (10.3 vs 9.4% p=0.062), pre-term deliveries (6.6 vs 6.4% p=0.533), hypoglycaemia (3.2 vs 2.8%, p=0.140), respiratory distress (5.5 vs 5.0%, p=0.210) and jaundice (5.6 vs 4.9%, p=0.053). The rate of LGA was similar to all women with a FBG <4.7 mmol/L across both groups. Primary caesarean section rate between the two groups was also similar (18.4 vs 18.4% p=0.910). The MS group had fewer inductions than the CS group (34.2 vs 39.8%, p<0.010). MS substantially reduced the need for an OGTT by 76%. Over 80% of those with a FBG 4.7-5.0 mmol/L in the MS group were adherent with proceeding to an OGTT. Women from Central/ South East Asia were more likely to have a FBG <4.7 mmol/L. Overall, women with a FBG <4.7 mmol/L by MS had non-inferior outcomes compared to women with a FBG <4.7 mmol/L by CS, independent of a subsequent diagnosis of GDM.

 

Conclusion:

In a large multi-ethnic cohort with a high prevalence of GDM, a modified screening strategy had non-inferior perinatal outcomes while greatly reducing the need for resource intensive OGTTs. A prospective randomised trial to further evaluate these findings is required.

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