Managing Gestational Diabetes Mellitus during COVID-19 - Maternal and neonatal Outcomes using Telemedical Approaches

JMIR Pediatr Parent. 2021 May 26. doi: 10.2196/28630. Online ahead of print.

ABSTRACT

BACKGROUND: In 2019, a new coronavirus has emerged in China and was rapidly classified as a pandemic. Pregnant women with GDM are considered risk patients for a severe course of COVID-19. In the context of the COVID-19-pandemic and with a focus on women with GDM, there are serious concerns regarding adverse effects on maternal and neonatal outcomes. Effective treatments for GDM patients are therefore particularly important. Due to the contact restrictions and infection risks, digital approaches such as telemedicine are suitable. Against this background, it is important to focus on pregnant women with GDM in more detail in the context of COVID-19 and with a view to telemedical treatment options.

OBJECTIVE: This systematic review aimes to summarize currently available evidence on maternal and offspring outcomes of pregnant women with GDM and COVID-19 (1) and to examine telemedical interventions to improve maternal glycemic control during COVID-19-pandemic (2).

METHODS: Publications were systematically identified by searching the databases Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, EMBASE, and CINAHL for studies published until March 2021. We sorted the COVID-19 studies (1) by outcomes and divided the telemedical intervention studies (2) into two groups: web-based and app-based. We analyzised case reports (COVID-19 studies) and randomized as well as non-randomized controlled clinical trials (telemedicine studies). For determining the change in HbA1c, we pooled appropriate studies and calculated the difference in means, with 95% confidence interval (CI) for the intervention and control group at the end of the interventions.

RESULTS: Regarding COVID-19 studies, we identified n=11 case reports, n=3 letter, n=1 case series and n=1 retrospective single center study. In total, n=41 patients with GDM and COVID-19 were analyzed. The maternal and neonatal outcomes were extremely heterogeneous. We identified adverse outcomes for mother and child through the interaction of GDM and COVID-19 such as cesarean sections, admission to (neonatal) intensive care unit, ventilation, and low Apgar scores. Furthermore, we selected n=9 telemedicine-related articles: n=6 were RCTs, n=2 CCTs and n=1 quasi-experimental design. In total, we analyzed n=480 GDM patients in the intervention and n=494 in the control groups. Of the n=9 telemedical studies, 4 were rated as strong, 4 were rated as moderate and 1 as weak quality studies. Telemedical interventions, in particular web-based and app-based treatments, can contribute to favourable impacts on HbA1c and FBG values in the context of the COVID-19 pandemic. The aMeta-analysis revealed a an effect size of mean difference in HbA1c of -0.19 % (95% CI: 0.34 to 0.03) for all telemedical interventions, MD = -0.138 % (95% CI: -0.,24 to -0.,04) for web-based interventions and MD = -0.305 % (96% CI: -0.,88 to 0.,27) for app-based interventions.

CONCLUSIONS: Telemedicine is an effective approach in the context of COVID-19 and GDM, as it provides social distancing and represents an optimal care of GDM patients, especially with regard to glycemic control, which is very important in view of the identified adverse maternal and neonatal outcomes. Further research is needed.

PMID:34081604 | DOI:10.2196/28630