Approaches to screening for hyperglycaemia in pregnant women during and after the COVID-19 pandemic

Meek, C.L., Lindsay, R.S. , Scott, E.M., Aiken, C.E., Myers, J., Reynolds, R.M., Simmons, D., Yamamoto, J.M., McCance, D.R. and Murphy, H.R. (2021) Approaches to screening for hyperglycaemia in pregnant women during and after the COVID-19 pandemic. Diabetic Medicine, 38(1), e14380. (doi: 10.1111/dme.14380) (PMID:32750184) (PMCID:PMC7436759)

Abstract

Aim: To evaluate the diagnostic and prognostic performance of alternative diagnostic strategies to oral glucose tolerance tests, including random plasma glucose, fasting plasma glucose and HbA1c, during the COVID‐19 pandemic. Methods: Retrospective service data (Cambridge, UK; 17 736 consecutive singleton pregnancies, 2004–2008; 826 consecutive gestational diabetes pregnancies, 2014–2019) and 361 women with ≥1 gestational diabetes risk factor (OPHELIA prospective observational study, UK) were included. Pregnancy outcomes included gestational diabetes (National Institute of Health and Clinical Excellence or International Association of Diabetes and Pregnancy Study Groups criteria), diabetes in pregnancy (WHO criteria), Caesarean section, large‐for‐gestational age infant, neonatal hypoglycaemia and neonatal intensive care unit admission. Receiver‐operating characteristic curves and unadjusted logistic regression were used to compare random plasma glucose, fasting plasma glucose and HbA1c performance. Results: Gestational diabetes diagnosis was significantly associated with random plasma glucose at 12 weeks [area under the receiver‐operating characteristic curve for both criteria 0.81 (95% CI 0.79–0.83)], fasting plasma glucose [National Institute of Health and Clinical Excellence: area under the receiver‐operating characteristic curve 0.75 (95% CI 0.65–0.85); International Association of Diabetes and Pregnancy Study Groups: area under the receiver‐operating characteristic curve 0.92 (95% CI 0.85–0.98)] and HbA1c at 28 weeks' gestation [National Institute of Health and Clinical Excellence: 0.83 (95% CI 0.75–0.90); International Association of Diabetes and Pregnancy Study Groups: 0.84 (95% CI 0.77–0.91)]. Each measure predicts some, but not all, pregnancy outcomes studied. At 12 weeks, ~5% of women would be identified using random plasma glucose ≥8.5 mmol/l (sensitivity 42%; specificity 96%) and at 28 weeks using HbA1c ≥39 mmol/mol (sensitivity 26%; specificity 96%) or fasting plasma glucose ≥5.2–5.4 mmol/l (sensitivity 18–41%; specificity 97–98%). Conclusions: Random plasma glucose at 12 weeks, and fasting plasma glucose or HbA1c at 28 weeks identify women with hyperglycaemia at risk of suboptimal pregnancy outcomes. These opportunistic laboratory tests perform adequately for risk stratification when oral glucose tolerance testing is not available.

• Item Type: Articles
• Additional Information: The OPHELIA study was supported by a grant from the European Foundation for the Study of Diabetes ‐ Sanofi grant for innovative outcomes in diabetes (autoantibody pilot study) and subsequently by a National Institute of Health Research (NIHR) Clinical Research Network chief investigator award. The OPHELIA study is supported with staff time from the NIHR Clinical Research Network. H.R.M. conducts independent research supported by the NIHR (Career Development Fellowship, CDF‐2013‐06‐035), and is supported by Tommy’s charity. C.L.M. is supported by the Diabetes UK Harry Keen Intermediate Clinical Fellowship (DUK‐HKF 17/0005712) and the EFSD‐Novo Nordisk Foundation Future Leader’s Award (NNF19SA058974). R.R. acknowledges the support of Tommy's and the British Heart Foundation (RE/18/5/34216).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lindsay, Dr Robert
• Authors: Meek, C.L., Lindsay, R.S., Scott, E.M., Aiken, C.E., Myers, J., Reynolds, R.M., Simmons, D., Yamamoto, J.M., McCance, D.R., and Murphy, H.R.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Diabetic Medicine
• Publisher: Wiley
• ISSN: 0742-3071
• ISSN (Online): 1464-5491
• Published Online: 04 August 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in Diabetic Medicine 38(1):e14380
• Publisher Policy: Reproduced under a Creative Commons License