Aim: Nutrition therapy is a key component in the management of gestational diabetes mellitis (GDM). Therapy can be delivered in various formats, including in-person, tele-health, individual and group settings. The COVID pandemic in 2020 limited the capacity to provide in-person therapy and potentially impacted the lifestyles of patients, including dietary habits. This study investigated glycaemic, dietary and pregnancy outcomes of women with GDM during the pandemic.
Methods: Retrospective observational GDM data was collected prior to and during the COVID pandemic. A pre-COVID cohort (n=96, 2019) received initial nutrition education via a one-hour in-person group, whereas a during-COVID cohort (n=100, 2020) received a written information package and 0-10 minute group session. Blood glucose (BG) ranges and elevations were noted one week later, along with carbohydrate intake ranges, meal/snack skipping, food group inadequacies and dietary knowledge deficits. Subsequent commencement of diabetes medications and birth outcomes were noted (mode of delivery, small and large for gestational age infants, neonatal hypoglycaemia, admission to neonatal intensive care, perinatal death).
Results: Fasting and postprandial BG ranges the week following initial education were lower during the COVID period (all P <0.02). For example the average difference between lowest and highest BG post dinner was 0.5 vs 0.9 mmol/L (P=0.01). Even so, there were no significant differences in BG elevations. A higher number during COVID had an inadequate intake from the fruit (43% vs 30%, P=0.043) and meat/alternatives groups (29% vs 17%, P=0.043). There were no significant differences for other core food groups, carbohydrate ranges or meal/snack skipping. More women during the COVID period were diagnosed with dietary knowledge deficits (57% vs 25%, P<0.001), however fewer women subsequently commenced diabetes medications (insulin 40.0% verses 54.2%, P=0.047; metformin 16.7 verses 6.0%, P=0.018). There were no differences in birth outcomes between the cohorts.
Conclusions: This study produced mixed findings in BG, dietary and medication outcomes for women with GDM prior to and during the COVID pandemic. Women had lower BG ranges the week following initial education and lower rates of subsequent diabetes medication commencement during COVID. This may suggest a favourable impact of the pandemic on lifestyles, however the findings may have been susceptible to fictitious reporting during telephone consultations. Conversely, dietary knowledge and the intake of two food groups were poorer in the COVID period the week following initial education. Overall, no major impacts on GDM outcomes were identified during the pandemic, despite changes in service delivery.