Association of prior COVID-19 infection with gestational diabetes mellitus

There is an increase incidence of diabetes and anti-hyperglycemic use after COVID-19 infection in non-pregnant adult populations. COVID-19 has also been shown to be associated with adverse pregnancy outcomes such as pre-eclampsia and preterm birth.

To evaluate if COVID-19 infection during preconception or in early pregnancy is associated with increased risk of gestational diabetes mellitus (GDM) diagnosis.

We performed a retrospective matched cohort study of patients delivering at two university affiliated hospitals from 6/1/2021 to 12/31/2021, prior to widespread vaccinations or home antigen testing for SARS-CoV-2. We included pregnant individuals aged 18 to 45 who were ≥ 24 weeks gestational age at time of delivery. We excluded those with a history of pre-gestational diabetes, multiple gestation, or prior diagnosis of cystic fibrosis or pancreatic insufficiency. Subjects with confirmed COVID-19 infection during preconception or the first 20 weeks of pregnancy were identified as cases and were matched 1:1 by age and BMI with eligible controls. GDM diagnosis was based on a two-step approach using Carpenter-Coustan criteria. Kruskal-Wallis and Chi-Square tests were performed as appropriate.

During the study period, 183 cases with prior positive COVID-19 antigen test and 1066 potential controls were identified. One case could not be matched due to an outlier BMI; therefore 182 matched patients were included in each group. The cases were less likely to have public insurance and more likely to have reported thyroid disorder, sleep apnea, or asthma. No differences were seen in GDM incidence between the cases and controls (OR 0.75, 95% CI 0.38-1.46) or based on timing of COVID-19 infection (p = 0.097). No differences were noted in delivery method, obstetrical lacerations, or Apgar scores.

COVID-19 infection in the preconception or early pregnancy period was not associated with increased incidence of GDM.