COVID-19 containment policies and hyperglycemia in pregnancy: correlation with the Stringency Index in a nationwide Belgian cohort
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Introduction
During the COVID-19 pandemic, gestational diabetes mellitus (GDM) prevalence showed variable changes across regions, with most reporting increases and others decreases; anxiety and lifestyle modifications linked to pandemic-related restrictions have been proposed as potential contributors in case of increase, while changes to less stringent screening strategies in case of decrease. The correlation of the GDM variation according to the intensity of pandemic restrictions has not been described to date. Our study aimed to examine the correlation between hyperglycemia in pregnancy (HIP) prevalence and pandemic-related restrictions measured by the Stringency Index (SI) and compare neonatal weight percentiles between the pre pandemic and the pandemic period.
Materials and Methods
We included all singleton live births in Belgium in 2019 and 2020 from Belgian birth registry data (n=229,170). We compared monthly proportions of HIP prevalence and Small for gestational age (SGA) and Large for gestional age (LGA) newborns in 2019 and 2020. Crude and adjusted odds ratios (ORs, aORs) for socio-economic status, maternal age, parity and BMI were estimated with logistic and multinomial regression. The Spearman correlation coefficient was used to assess the correlation between the monthly average SI and the monthly aORs of HIP.
Results
For deliveries from January to June 2020, no significant differences in HIP prevalence were observed compared with 2019. For births occurred July to December 2020, there was a significant increase in HIP, with peaks in July (GDM screening in April) (aOR 1.41, 1.26–1.58) and November (GDM screening in August) (aOR 1.33, 95% CI 1.18–1.49). The Spearman correlation coefficient between the SI and HIP aORs was 0.82 (p = 0.01).There was no significant change in neonatal weight percentiles.
Conclusion
During the pandemic, we observed an increase in the prevalence of HIP and its increase during the was strongly correlated with the corresponding SI. There was no measurable impact on the frequency of LGA or SGA newborns. These results may be useful to anticipate unintended consequences of future public health emergencies requiring similar containment measures.
