• H David McIntyre, Kristen S Gibbons, Ma Ronald C W RCW Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong; Li Ka Shing Institute of Health Sciences, The Chinese Universit, Wing Hung Tam, David A Sacks, Julia Lowe, Lene R Madsen, and Patrick M Catalano.
• Mater Research Institute, The University of Queensland, South Brisbane, Australia. Electronic address: David.mcintyre@mater.org.au.
• Diabetes Res. Clin. Pract. 2020 Sep 1; 167: 108353.

AimsWe assessed how altered diagnostic processes and criteria for gestational diabetes mellitus (GDM) recommended by the United Kingdom (UK), Canada and Australia for use during the COVID-19 pandemic would affect both GDM frequency and related adverse outcomes.MethodsSecondary analysis of 5974 HAPO study women with singleton pregnancies who underwent 75 g OGTTs and HbA1c assays between 24 and 32 weeks' gestation and who received no treatment for GDM.ResultsAll post COVID-19 modified pathways reduced GDM frequency - UK (81%), Canada (82%) and Australia (25%). Canadian women whose GDM would remain undetected post COVID-19 (missed GDMs) displayed similar rates of pregnancy complications to those with post COVID-19 GDM. Using UK modifications, the missed GDM group were at slightly lower risk whilst the women missed using the Australian modifications were at substantially lower risk.ConclusionsThe modifications in GDM diagnosis proposed for the UK, Canada and Australia result in differing reductions of GDM frequency. Each has both potential benefits in terms of reduction in potential exposure to COVID-19 and costs in terms of missed opportunities to influence pregnancy and postpartum outcomes. These factors should be considered when deciding which protocol is most appropriate for a particular context.Copyright © 2020 Elsevier B.V. All rights reserved.

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