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Pandemic-related changes to diabetes care during pregnancy may be here to stay


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3 minutes

In 2020, health care providers had to adapt how they manage chronic, noncommunicable diseases like diabetes alongside a novel infectious disease. COVID-19, Diabetes, and Pregnancy—The Perfect Storm? will examine how clinicians modified diabetes care for pregnant women during the pandemic and what changes are likely to be retained. The session will begin at 11:30 a.m. ET on Friday, June 25.

David McIntyre, MD, FRACP
David McIntyre, MD, FRACP

“Despite the fact that it can be quite a severe disease, there’s not much evidence COVID is worse during pregnancy than it is at other times,” said David McIntyre, MD, FRACP. Pregnant women also are typically younger than the whole of the population, so their complication rates if they do contract COVID-19 are lower than for older individuals, he noted.

Dr. McIntyre, Director of Obstetric Medicine and Head of the Mater Clinical Unit at the University of Queensland, Australia, will discuss new data on the diagnosis and management of diabetes in pregnancy.

New approaches to detecting gestational diabetes instituted during the pandemic vary by country and have been influenced by what was being done previously, local COVID-19 infection rates, and local pandemic responses, he said. In some locations, the switch was made from a three-hour glucose tolerance test that put the pregnant woman in contact with several people over an extended period, thereby increasing her chance of COVID-19 infection, to a simpler A1C or fasting glucose test.

The evolution of health care delivery amid COVID-19 also has seen providers tapping into existing tools with new urgency. Wide use of telehealth increased equity and access to care in countries like Australia, where people may live several hundred miles from the nearest health care center. And because blood glucose, blood pressure, and other measurements can be monitored effectively at a distance, Dr. McIntyre predicts there will be a broader use of telemedicine in the future to support women’s health care during pregnancy.

Noelia M. Zork, MD
Noelia M. Zork, MD

“If there’s a way that we can make medical care more convenient for patients, everybody wins,” said Noelia M. Zork, MD, Assistant Clinical Professor and Director of the Diabetes in Pregnancy Program for the Department of Obstetrics and Gynecology at Columbia University Irving Medical Center. “Telehealth definitely adds an element of convenience to make it so that women are able to get the care they need and not have to worry about leaving their work early or finding someone to take care of their kids because they can do it from the comfort of their home or in their break room at work.”

Dr. Zork will outline evidence-based practices for using telemedicine to manage all types of diabetes in pregnancy, including low-cost ways to integrate telehealth into everyday clinical care.

“We think, sometimes, telemedicine has to be this fancy, expensive thing,” she said. “Even talking to a patient over the phone is a form of telehealth.”

The response to telemedicine is overwhelmingly positive on patient satisfaction surveys, Dr. Zork noted, with convenience being a large contributing factor. And convenience translates into greater accessibility for many patients juggling the clinically intense schedule that accompanies pregnancy with a dozen or more prenatal care visits, ultrasounds, and bloodwork, she added.

“The pandemic forced our hand to start using these techniques to take care of our patients safely, but there are many good reasons to continue to invest in telemedicine moving forward,” Dr. Zork said.

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