Abstract：
BACKGROUND: Many of the adverse outcomes of gestational diabetes mellitus (GDM) are linked to excessive fetal growth, which is strongly mediated by the adequacy of maternal glycemic management. The COVID-19 pandemic led to a rapid adoption of virtual care models. We aimed to compare glycemic management, fetal growth, and perinatal outcomes before and during the COVID-19 pandemic.
METHODS: A retrospective cohort study was conducted between 2017 and 2020. Singleton pregnancies complicated by GDM were included in the study. The cohort was stratified into \"before\" and \"during\" COVID-19 subgroups, using March 11, 2020, as the demarcation time point. Women who began their GDM follow-up starting March 11, 2020, and thereafter were allocated to the COVID-19 era, whereas women who delivered before the demarcation point served as the pre-COVID-19 era. The primary outcome was the rate of large-for-gestational-age (LGA) neonates. Secondary outcomes included select maternal and neonatal adverse outcomes.
RESULTS: Seven hundred seventy-five women were included in the analysis, of which 187 (24.13%) were followed during the COVID-19 era and 588 (75.87%) before the COVID-19 era. One hundred seventy-one of the 187 women (91.44%) followed during COVID-19 had at least 1 virtual follow-up visit. No virtual follow-up visits occurred before the COVID-19 era. There was no difference in the rate of LGA neonates between groups on both univariate (5.90% vs 7.30%, p=0.5) and multivariate analyses, controlling for age, ethnicity, parity, body mass index, gestational weight gain, chronic hypertension, smoking, and hypertensive disorders in pregnancy (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 0.49 to 2.51, p=0.80). In the multivariate analysis, there was no difference in composite neonatal outcome between groups (GDM diet: aOR 1.40, 95% CI 0.81 to 2.43, p=0.23; GDM medical treatment: aOR 1.20, 95% CI 0.63 to 2.43, p=0.5).
CONCLUSIONS: After adjusting for differences in baseline variables, the combined virtual mode of care was not associated with a higher rate of LGA neonates or other adverse perinatal outcomes in women with GDM. Larger studies are needed to better understand the specific impact of virtual care on less common outcomes in pregnancies with GDM.
METHODS: A retrospective cohort study was conducted between 2017 and 2020. Singleton pregnancies complicated by GDM were included in the study. The cohort was stratified into \"before\" and \"during\" COVID-19 subgroups, using March 11, 2020, as the demarcation time point. Women who began their GDM follow-up starting March 11, 2020, and thereafter were allocated to the COVID-19 era, whereas women who delivered before the demarcation point served as the pre-COVID-19 era. The primary outcome was the rate of large-for-gestational-age (LGA) neonates. Secondary outcomes included select maternal and neonatal adverse outcomes.
RESULTS: Seven hundred seventy-five women were included in the analysis, of which 187 (24.13%) were followed during the COVID-19 era and 588 (75.87%) before the COVID-19 era. One hundred seventy-one of the 187 women (91.44%) followed during COVID-19 had at least 1 virtual follow-up visit. No virtual follow-up visits occurred before the COVID-19 era. There was no difference in the rate of LGA neonates between groups on both univariate (5.90% vs 7.30%, p=0.5) and multivariate analyses, controlling for age, ethnicity, parity, body mass index, gestational weight gain, chronic hypertension, smoking, and hypertensive disorders in pregnancy (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 0.49 to 2.51, p=0.80). In the multivariate analysis, there was no difference in composite neonatal outcome between groups (GDM diet: aOR 1.40, 95% CI 0.81 to 2.43, p=0.23; GDM medical treatment: aOR 1.20, 95% CI 0.63 to 2.43, p=0.5).
CONCLUSIONS: After adjusting for differences in baseline variables, the combined virtual mode of care was not associated with a higher rate of LGA neonates or other adverse perinatal outcomes in women with GDM. Larger studies are needed to better understand the specific impact of virtual care on less common outcomes in pregnancies with GDM.
摘要：
背景：妊娠期糖尿病（GDM）的许多不良结局与胎儿过度生长有关，这是由母体血糖控制的充分性介导的。COVID-19大流行导致虚拟护理模式的迅速采用。我们的目的是比较血糖控制，胎儿生长,和COVID-19大流行之前和期间的围产期结局。
方法：2017年至2020年进行了一项回顾性队列研究。合并GDM的单胎妊娠被纳入研究。将队列分为“之前”和“期间”COVID-19亚组，以2020年3月11日为分界时间点。从2020年3月11日开始GDM随访的女性，此后被分配到COVID-19时代，而在分界点之前分娩的女性则是前COVID-19时代。主要结局是大胎龄（LGA）新生儿的发生率。次要结局包括选择的产妇和新生儿不良结局。
结果：775名妇女被纳入分析，其中187例（24.13%）在COVID-19时代随访，588例（75.87%）在COVID-19时代之前随访。在COVID-19期间，187名女性(91.44%)接受了至少1次虚拟随访。在COVID-19时代之前没有虚拟随访。两组单变量的LGA新生儿发生率无差异(5.90%vs7.30%,p=0.5)和多变量分析，控制年龄，种族,奇偶校验，身体质量指数,妊娠期体重增加,慢性高血压,吸烟,和妊娠期高血压疾病(校正比值比[aOR]1.11,95%置信区间[CI]0.49~2.51,p=0.80).在多变量分析中，两组间复合新生儿结局无差异(GDM饮食:aOR1.40,95%CI0.81~2.43,p=0.23;GDM药物治疗:aOR1.20,95%CI0.63~2.43,p=0.5)。
结论：调整基线变量的差异后，在GDM女性患者中,复合虚拟护理模式与较高的LGA新生儿发生率或其他不良围产期结局无关.需要更大规模的研究来更好地了解虚拟护理对GDM妊娠中较不常见结局的具体影响。
方法：2017年至2020年进行了一项回顾性队列研究。合并GDM的单胎妊娠被纳入研究。将队列分为“之前”和“期间”COVID-19亚组，以2020年3月11日为分界时间点。从2020年3月11日开始GDM随访的女性，此后被分配到COVID-19时代，而在分界点之前分娩的女性则是前COVID-19时代。主要结局是大胎龄（LGA）新生儿的发生率。次要结局包括选择的产妇和新生儿不良结局。
结果：775名妇女被纳入分析，其中187例（24.13%）在COVID-19时代随访，588例（75.87%）在COVID-19时代之前随访。在COVID-19期间，187名女性(91.44%)接受了至少1次虚拟随访。在COVID-19时代之前没有虚拟随访。两组单变量的LGA新生儿发生率无差异(5.90%vs7.30%,p=0.5)和多变量分析，控制年龄，种族,奇偶校验，身体质量指数,妊娠期体重增加,慢性高血压,吸烟,和妊娠期高血压疾病(校正比值比[aOR]1.11,95%置信区间[CI]0.49~2.51,p=0.80).在多变量分析中，两组间复合新生儿结局无差异(GDM饮食:aOR1.40,95%CI0.81~2.43,p=0.23;GDM药物治疗:aOR1.20,95%CI0.63~2.43,p=0.5)。
结论：调整基线变量的差异后，在GDM女性患者中,复合虚拟护理模式与较高的LGA新生儿发生率或其他不良围产期结局无关.需要更大规模的研究来更好地了解虚拟护理对GDM妊娠中较不常见结局的具体影响。
