{"title":"Impact of changes in gestational diabetes mellitus diagnostic criteria during the COVID-19 pandemic.","authors":"Jessica Neville, Kelly Foley, Seán Lacey, Antoinette Tuthill, Oratile Kgosidialwa, Mairead O'Riordan, Fiona O'Halloran, Seán J Costelloe","doi":"10.1007/s11845-025-03926-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background/aims: </strong>During the COVID-19 pandemic, the Health Service Executive (HSE) and Royal College of Obstetricians and Gynaecologists (RCOG) recommended fasting and random plasma glucose (FPG/RPG) alongside glycated haemoglobin (HbA<sub>1c</sub>) to replace the oral glucose tolerance test (OGTT) for diagnosing Gestational Diabetes Mellitus (GDM).</p><p><strong>Methods: </strong>The study compared testing patterns and diagnostic rates for GDM before and after implementing the RCOG guidelines (01/05/2020) in pregnancies beginning 01/11/2018 to 31/03/2021. Trends were inspected using Cochrane-Armitage tests. Differences between General Practice (GP) and Secondary Care (SCare) were assessed by chi-square analysis. A significance level of p < 0.05 was used for all analyses. Information on maternal and pregnancy characteristics was accessed where available.</p><p><strong>Results: </strong>Data indicated a significant reduction in OGTTs requested by GPs and SCare. Conversely, HbA<sub>1c</sub>, FPG and RPG test requests increased significantly in both locations. The overall GDM positivity rate increased significantly from 7.4% to 22.0% in GP and 16.9% to 39.0% in SCare following RCOG guideline implementation.</p><p><strong>Conclusions: </strong>The RCOG guidelines appear to have been well adopted by GPs and SCare, with greater adherence in SCare. Using FPG, RPG and HbA<sub>1c</sub> to a greater extent than the OGTT corresponded with increased GDM diagnostic rates. Given the difficulties with interpreting HbA<sub>1c</sub> in pregnancy, its routine use in diagnosing GDM requires further careful consideration. Relaying changes in diagnostic protocol during pandemics requires strong communication with all requesting clinicians, including GPs. Comparisons between GP and SCare indicated significant differences in test-requesting practices and GDM positivity rates.</p>","PeriodicalId":14507,"journal":{"name":"Irish Journal of Medical Science","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Irish Journal of Medical Science","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11845-025-03926-3","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Background/aims: During the COVID-19 pandemic, the Health Service Executive (HSE) and Royal College of Obstetricians and Gynaecologists (RCOG) recommended fasting and random plasma glucose (FPG/RPG) alongside glycated haemoglobin (HbA1c) to replace the oral glucose tolerance test (OGTT) for diagnosing Gestational Diabetes Mellitus (GDM).
Methods: The study compared testing patterns and diagnostic rates for GDM before and after implementing the RCOG guidelines (01/05/2020) in pregnancies beginning 01/11/2018 to 31/03/2021. Trends were inspected using Cochrane-Armitage tests. Differences between General Practice (GP) and Secondary Care (SCare) were assessed by chi-square analysis. A significance level of p < 0.05 was used for all analyses. Information on maternal and pregnancy characteristics was accessed where available.
Results: Data indicated a significant reduction in OGTTs requested by GPs and SCare. Conversely, HbA1c, FPG and RPG test requests increased significantly in both locations. The overall GDM positivity rate increased significantly from 7.4% to 22.0% in GP and 16.9% to 39.0% in SCare following RCOG guideline implementation.
Conclusions: The RCOG guidelines appear to have been well adopted by GPs and SCare, with greater adherence in SCare. Using FPG, RPG and HbA1c to a greater extent than the OGTT corresponded with increased GDM diagnostic rates. Given the difficulties with interpreting HbA1c in pregnancy, its routine use in diagnosing GDM requires further careful consideration. Relaying changes in diagnostic protocol during pandemics requires strong communication with all requesting clinicians, including GPs. Comparisons between GP and SCare indicated significant differences in test-requesting practices and GDM positivity rates.
期刊介绍:
The Irish Journal of Medical Science is the official organ of the Royal Academy of Medicine in Ireland. Established in 1832, this quarterly journal is a contribution to medical science and an ideal forum for the younger medical/scientific professional to enter world literature and an ideal launching platform now, as in the past, for many a young research worker.
The primary role of both the Academy and IJMS is that of providing a forum for the exchange of scientific information and to promote academic discussion, so essential to scientific progress.