Pregnancy and perinatal outcomes in women with pre-gestational diabetes before and during the COVID-19 pandemic

Wing Cheung Pun; Po Lam So; Kar Hung Siong

doi:10.12809/hkjgom.23.2.340

Authors

Wing Cheung Pun
Po Lam So
Kar Hung Siong

DOI:

https://doi.org/10.12809/hkjgom.23.2.340

Keywords:

COVID-19, Pregnancy, high-risk, Pregnancy in diabetics, Pregnancy outcome

Abstract

Objective: This study compared the compliance with scheduled antenatal visits as well as pregnancy and perinatal outcomes of pregnant women with pre-gestational diabetes before and during the COVID-19 pandemic.
Methods: Medical records of women with singleton pregnancies and pre-gestational type I or type II diabetes who attended antenatal care at Tuen Mun Hospital between 1 September 2017 and 31 March 2022 were retrieved. Modifiable and non-modifiable risk factors associated with adverse pregnancy outcomes were analysed, including glycated haemoglobin levels, body mass index, smoking status, attendance of antenatal follow-up, maternal age, parity, ethnicity, diabetes type, pre-pregnancy medical conditions, Caesarean section rate, hypertensive disorders complicating pregnancy, preterm birth (birth at <37 weeks of gestation), and large and small for gestational age.
Results: Of 152 women included in the analysis, 74 attended between 4 January 2020 and 31 March 2022 (the pandemic group) and 78 attended between 1 September 2017 and 3 January 2020 (the pre-pandemic group). The two groups were comparable in terms of compliance with their scheduled antenatal visits and all pregnancy and perinatal outcomes, except that the pandemic group had higher rates of emergency Caesarean sections (44.6% vs 23.5%, p=0.010) and neonatal hypoglycaemia (51.6% vs 34.3%, p=0.046). Both groups had good glycaemic control.
Conclusion: In women with pre-gestational diabetes, the rate of emergency Caesarean sections significantly increased during the pandemic, although compliance with scheduled antenatal visits and maternal and neonatal outcomes were similar before and during the pandemic. This suggests that the quality and accessibility of maternity care were not compromised by the pandemic.

References

Bogin B, Varea C. COVID-19, crisis, and emotional stress: a biocultural perspective of their impact on growth and development for the next generation. Am J Hum Biol 2020;32:e23474.

Karavadra B, Stockl A, Prosser-Snelling E, Simpson P, Morris E. Women's perceptions of COVID-19 and their healthcare experiences: a qualitative thematic analysis of a national survey of pregnant women in the United Kingdom. BMC Pregnancy Childbirth 2020;20:600.

Kotlar B, Gerson EM, Petrillo S, Langer A, Tiemeier H. The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review. Reprod Health 2021;18:10.

Landrian A, Mboya J, Golub G, Moucheraud C, Kepha S, Sudhinaraset M. Effects of the COVID-19 pandemic on antenatal care utilisation in Kenya: a cross-sectional study. BMJ Open 2022;12:e060185.

Hospital Authority Clinical Data Analysis and Reporting System, Hospital Authority, Hong Kong SAR.

Hung KK, Walline JH, Chan EYY, et al. Health service utilization in Hong Kong during the COVID-19 pandemic: a cross-sectional public survey. Int J Health Policy Manag 2022;11:508-13.

Hay WW Jr. Placental-fetal glucose exchange and fetal glucose metabolism. Trans Am Clin Climatol Assoc 2006;117:321-40.

Di Cianni G, Miccoli R, Volpe L, Lencioni C, Del Prato S. Intermediate metabolism in normal pregnancy and in gestational diabetes. Diabetes Metab Res Rev 2003;19:259-70. DOI: https://doi.org/10.1002/dmrr.390

Murphy HR, Howgate C, O'Keefe J, et al. Characteristics and outcomes of pregnant women with type 1 or type 2 diabetes: a 5-year national population-based cohort study. Lancet Diabetes Endocrinol 2021;9:153-64.

Evers IM, de Valk HW, Visser GH. Risk of complications of pregnancy in women with type 1 diabetes: nationwide prospective study in the Netherlands. BMJ 2004;328:915. DOI: https://doi.org/10.1136/bmj.38043.583160.EE

Malaza N, Masete M, Adam S, Dias S, Nyawo T, Pheiffer C. A systematic review to compare adverse pregnancy outcomes in women with pregestational diabetes and gestational diabetes. Int J Environ Res Public Health 2022;19:10846.

Negrato CA, Mattar R, Gomes MB. Adverse pregnancy outcomes in women with diabetes. Diabetol Metab Syndr 2012;4:41. DOI: https://doi.org/10.1186/1758-5996-4-41

Ong JL, Lau TY, Massar SAA, et al. COVID-19-related mobility reduction: heterogenous effects on sleep and physical activity rhythms. Sleep 2021;44:zsaa179.

Clemente-Suárez VJ, Beltrán-Velasco AI, Ramos-Campo DJ, et al. Physical activity and COVID-19. The basis for an efficient intervention in times of COVID-19 pandemic. Physiol Behav 2022;244:113667.

Castañeda-Babarro A, Arbillaga-Etxarri A, Gutiérrez-Santamaría B, Coca A. Physical activity change during COVID-19 confinement. Int J Environ Res Public Health 2020;17:6878.

Chmielewska B, Barrett I, Townsend R, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health 2021;9:e759-72.

Gurol-Urganci I, Waite L, Webster K, et al. Obstetric interventions and pregnancy outcomes during the COVID-19 pandemic in England: a nationwide cohort study. PLoS Med 2022;19:e1003884.

Office for National Statistics. Provisional Births in England and Wales: 2020. Available at: https://wwwonsgovuk/ peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/articles/ provisionalbirthsinenglandandwales/2020.

Birthplace in England Collaborative Group, Brocklehurst P, Hardy P, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ 2011;343:d7400. DOI: https://doi.org/10.1136/bmj.d7400

Jardine J, Relph S, Magee L, et al. Maternity services in the UK during the coronavirus disease 2019 pandemic: a national survey of modifications to standard care. BJOG 2021;128:880-9.

Bourne T, Shah H, Falconieri N, et al. Burnout, well- being and defensive medical practice among obstetricians and gynaecologists in the UK: cross-sectional survey study. BMJ Open 2019;9:e030968.

Philip RK, Purtill H, Reidy E, et al. Unprecedented reduction in births of very low birthweight (VLBW) and extremely low birthweight (ELBW) infants during the COVID-19 lockdown in Ireland: a 'natural experiment' allowing analysis of data from the prior two decades. BMJ Glob Health 2020;5:e003075.

Khalil A, von Dadelszen P, Draycott T, Ugwumadu A, O'Brien P, Magee L. Change in the incidence of stillbirth and preterm delivery during the COVID-19 pandemic. JAMA 2020;324:705-6. DOI: https://doi.org/10.1001/jama.2020.12746

Khalil A, von Dadelszen P, Kalafat E, et al. Change in obstetric attendance and activities during the COVID-19 pandemic. Lancet Infect Dis 2021;21:e115.

Goyal M, Singh P, Singh K, Shekhar S, Agrawal N, Misra S. The effect of the COVID-19 pandemic on maternal health due to delay in seeking health care: experience from a tertiary center. Int J Gynaecol Obstet 2021;152:231-5.

Justman N, Shahak G, Gutzeit O, et al. Lockdown with a price: the impact of the COVID-19 pandemic on prenatal care and perinatal outcomes in a tertiary care center. Isr Med Assoc J 2020;22:533-7.

Fernández E, Cortazar A, Bellido V. Impact of COVID-19 lockdown on glycemic control in patients with type 1 diabetes. Diabetes Res Clin Pract 2020;166:108348.

Eberle C, Stichling S. Impact of COVID-19 lockdown on glycemic control in patients with type 1 and type 2 diabetes mellitus: a systematic review. Diabetol Metab Syndr 2021;13:95.

Newman C, Egan AM, Ahern T, et al. Diabetes care and pregnancy outcomes for women with pregestational diabetes in Ireland. Diabetes Res Clin Pract 2021;173:108685.

Hong Kong College of Obstetricians and Gynaecologists. Territory-wide audit in obstetrics and gynecology 2014. Available at: https://www.hkcog.org.hk/hkcog/Download/Territory-wide_Audit_in_Obstetrics_Gynaecology_2014.pdf.