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Published on: July 5, 2022
Evaluation of an Alternative Screening Method for Gestational Diabetes Diagnosis During the COVID-19 Pandemic
Alba Casellas1, Cristina Martínez2, Judit Amigó3
1Maternal-Foetal Medicine Unit, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, 08036 Barcelona, Spain.
Insights
An alternative gestational diabetes mellitus (GDM) screening method used during the COVID-19 pandemic showed lower GDM prevalence and comparable obstetrical and neonatal outcomes. This alternative approach was also more cost-effective than the standard method.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Public Health
Background:
- The COVID-19 pandemic necessitated evaluating alternative diagnostic criteria for gestational diabetes mellitus (GDM).
- Standard GDM screening methods were compared against an alternative approach utilizing plasma glucose and HbA1c.
- The study assessed GDM prevalence, maternal-fetal outcomes, and economic impact in Catalonia, Spain.
Purpose of the Study:
- To compare an alternative GDM diagnostic method with the standard method during the COVID-19 pandemic.
- To evaluate the impact on GDM prevalence, obstetrical and perinatal outcomes, and healthcare costs.
- To analyze outcomes in both the general pregnant population and a subgroup diagnosed with GDM.
Main Methods:
- A comparative cohort study involving pregnant individuals screened for GDM using standard versus alternative methods (plasma glucose and HbA1c).
- Data collected from 1543 (standard) and 2197 (alternative) participants across six hospitals in Spain (April 2020-April 2022).
- Primary outcome: large for gestational age rate; secondary outcomes: composite adverse maternal and neonatal complications, and cost analysis.
Main Results:
- The alternative screening method identified a lower GDM prevalence (6.9%) compared to the standard method (10.8%).
- No significant differences were observed in large for gestational age rates or composite adverse outcomes (pregnancy, delivery, neonatal complications) between the groups.
- The alternative screening method was significantly more cost-effective, with a mean cost of 46.0 euros versus 85.6 euros for the standard method.
Conclusions:
- The alternative GDM screening method resulted in lower diagnosed prevalence without compromising obstetrical or neonatal outcomes during the pandemic.
- This alternative approach offers a potentially more economical screening strategy for gestational diabetes mellitus.
- Findings suggest the feasibility and benefits of the alternative GDM diagnostic criteria in a real-world clinical setting during public health crises.
Abstract:
Background: To evaluate the impact of applying alternative diagnostic criteria for gestational diabetes mellitus (GDM) during the COVID-19 pandemic on GDM prevalence, obstetrical and perinatal outcomes, and costs, as compared to the standard diagnostic method. Methods: A cohort of pregnant individuals undergoing GMD screening with the alternative GDM method, which uses plasma glucose (fasting or non-fasting) and HbA1c, was compared with a cohort of pregnant individuals undergoing the standard GDM screening method. Both cohorts were obtained from six hospitals across Catalonia, Spain, from April 2020 to April 2022. The primary outcome was large for gestational age rate at birth. The secondary outcomes were composite adverse outcomes, including pregnancy complications, delivery complications, and neonatal complications. The cost differences between screening methods were also evaluated. A similar analysis was performed in the subgroup diagnosed with GDM. Results: Data were collected from 1543 pregnant individuals in the standard screening group and 2197 in the alternative screening group. The standard screening group had a higher GDM diagnostic rate than the alternative screening group (10.8% vs. 6.9%, respectively; p < 0.0001). The primary outcome (large for gestational age rate) was similar between groups: 200/1543 (13.0%) vs. 303/2197 (13.8%). The adjusted OR for this outcome was 1.74 (95% CI: 0.74-4.10). An adjusted analysis showed no differences between groups in the composite adverse outcomes for pregnancy complications (OR: 1.11; 95% CI: 0.91-1.36), delivery complications (OR: 0.95; 95% CI: 0.75-1.19), and neonatal complications (OR: 1.28; 95% CI: 0.94-1.75). Among individuals diagnosed with GDM, the large for gestational age rate was similar between groups: 13/166 (7.8%) vs. 15/151 (9.9%). The OR adjusted for this outcome was 1.24 (95% CI: 0.51-3.09). An adjusted analysis showed no differences in the composite adverse outcomes for pregnancy complications (OR: 1.57; 95% CI: 0.84-2.98), delivery complications (OR: 1.21; 95% CI: 0.63-2.35), and neonatal complications (OR: 1.35; 95% CI: 0.61-3.04). The mean cost (which included expenses for consumables, equipment, and personnel) of the alternative screening method was 46.0 euros (22.3 SD), as compared to 85.6 euros (67.5 SD) for the standard screening method. Conclusions: In this Spanish population during the COVID-19 pandemic, GDM prevalence was lower in the alternative screening group than in the standard screening group. After adjusting for GDM risk factors, outcomes related to obstetrics, delivery, and neonatal complications were comparable between both groups. Finally, the alternative screening method was cheaper than the standard screening method.
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