Impact of changes to national UK Guidance on testing for gestational diabetes screening during a pandemic: a...

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Public Health

Background:

• Gestational diabetes (GDM) poses risks to both mother and fetus.
• Standardized screening protocols are crucial for timely diagnosis and management.
• The COVID-19 pandemic necessitated adaptations in healthcare, including GDM screening.

Purpose of the Study:

• To compare the detection rates of GDM using the National Institute for Health and Clinical Excellence (NICE) guidelines versus the Royal College of Obstetricians and Gynaecologists (RCOG) COVID-19 pandemic recommendations.
• To evaluate the effectiveness of the RCOG's adapted GDM screening protocol during the pandemic.

Main Methods:

• A retrospective cohort study analyzed prospectively collected data from women delivering between January 2016 and May 2020.
• Data from a London Teaching Hospital was used.
• Detection rates were compared between NICE and RCOG criteria, with follow-up testing for women screening negative under RCOG guidelines.

Main Results:

• The RCOG guidance resulted in a significant decrease in GDM detection rates, from 7.7% to 4.2% (P=0.0003).
• Of 230 women who initially tested negative under RCOG criteria but underwent further testing, 47 (20.4%) were diagnosed with GDM per NICE criteria.
• The RCOG COVID-19 screening regime failed to detect 57% of women who were subsequently identified as having GDM.

Conclusions:

• The RCOG COVID-19 gestational diabetes screening protocol demonstrated a significantly lower detection rate compared to NICE guidelines.
• The adapted RCOG screening approach during the pandemic was insufficient and cannot be recommended for general use due to its failure to identify a substantial proportion of GDM cases.
• This highlights the importance of maintaining robust GDM screening protocols even during public health crises.