Poster Presentation International Association of the Diabetes and Pregnancy Study Groups 2022 - Hosted by ADIPS

Modified gestational diabetes screening and testing criteria during the COVID-19 pandemic: what were the views of consumers and clinicians during this time? (#89)

Nina Meloncelli 1 2 , Emma Shipton 3 , Jenny Doust , Michael d'Emden 4 , H. David McIntyre 5 , Leonie Callaway 1 3 , Susan de Jersey 1 6
  1. Perinatal Research Centre, Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
  2. Allied Health, Metro North Health, Brisbane, Queensland, Australia
  3. Women's and Newborn Services, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia
  4. Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia
  5. Mater Research, Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
  6. Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia

Background

In March 2020, Queensland Health introduced modified screening and diagnostic recommendations for gestational diabetes mellitus (GDM) in response to the COVID-19 pandemic. The recommendations included a two-step procedure [fasting blood glucose (FBG) test, followed by an oral glucose tolerance test (OGTT) for FBG > 4.7 and < 5.1 mmol/.  A FBG under 4.7 mmol/l was negative for GDM and over 5.1 mmol/l was positive. In the context of the ongoing GDM diagnosis debate, we saw an opportunity to investigate the perceptions of both consumers and clinicians regarding the usual vs modified GDM diagnosis recommendations.

Methods

Consumers (mothers who had undergone GDM testing under standard and modified recommendations), and clinicians (antenatal health care professionals) were recruited via emails, social media and media releases for telephone interviews between March and May 2021. Data were analysed separately using a reflexive thematic approach.

Results

Twenty-nine consumers and 17 clinicians participated in telephone interviews. The main themes expressed by consumer participants included: the need for information provision, evidence and informed decision making; acceptability of GDM screening (often influenced by previous screening and GDM diagnosis experiences); individualisation of screening; preferred GDM screening methods for the future. Clinician responses focused on the communication and implementation of changes; perceptions and value of the evidence base; and diversity in perception of GDM screening. Women were more likely to welcome the ease and convenience of the changes, unless a previous GDM experience made them cautious of a definitive diagnosis. Although many clinicians understood women’s dislike or inability to tolerate the OGTT, they largely felt the benefits of the OGTT outweighed the discomfort. In areas where GDM was more prevalent, clinicians expressed their concern about missed diagnoses while others felt that overdiagnosis was common and would support continued changes. Some clinicians indicated the need for a stronger evidence base to support ongoing changes and believed that many GDM patients would be missed under the modified criteria.

Conclusion

There remains ongoing debate over the best way to screen and the criteria to diagnose GDM. This study highlighted that while many women welcome a simplified screening and testing procedure, they wanted clear communication from antenatal care providers and the opportunity actively participant in their pregnancy care. Clinicians had diverse (and often strongly held) views when it came to the screening and diagnosis of GDM.