Pregnant women with gestational diabetes combined with periconceptional overweight or obesity were at increased risk of severe COVID-19, according to results of a prospective observational study.
This was particularly common in pregnant women who required insulin therapy, data from the COVID-19 Obstetric and Neonatal Outcome Study (CRONOS) showed.
“The most important thing for physicians to know is that not only pre-existing diabetes but also gestational diabetes is a risk factor for severe COVID-19, particularly when it occurs in obese individuals.” Ulrich Pecks, MD a professor in the Department of Obstetrics and Gynecology at the University Medical Center Schleswig-Holstein in Kiel, Germany, told Healio. “Presumably, the severity of the diabetic metabolic disease also plays a role.”
Although gestational diabetes (GDM) is known to be a common complication of pregnancy – the global prevalence was 13.4% in 2021 – research on the association of GDM and maternal and neonatal pregnancy outcomes in pregnant women infected with SARS-CoV-2 is lacking are.
Pecks and colleagues performed an analysis of 1,490 women (mean age 31 ± 5.2 years; 40.7% nulliparous) who had COVID-19 between April 3, 2020 and August 24, 2021, none of whom Pecks said were vaccinated became.
“A general recommendation for vaccination during pregnancy was only made in Germany in September 2021 … unfortunately the vaccination rates for pregnant women are still low at around 40 percent,” he said.
Maternal Results
Overall, the results indicated that GDM was not associated with adverse maternal outcomes (OR = 1.5; 95% CI, 0.88-2.57). However, women with overweight or obesity and GDM had an increased risk of adverse maternal consequences (adjusted OR = 2.69; 95% CI, 1.43-5.07). Women with GDM who were overweight or obese and required insulin therapy had an even greater risk of severe COVID-19 (aOR = 3.05; 95% CI, 1.38-6.73).
“According to our analyses, the BMI and a diabetic metabolic disease play the greatest role, ahead of maternal age and other pre-existing conditions such as asthma or high blood pressure,” says Pecks. “The only more important factor is the gestational age of the infection. Women in the third trimester have a significantly higher risk of severe disease than women in the first trimester.”
Pecks mentioned that the virus variant plays a role.
“With omicron we see significantly less severe courses than with the previous variants, but they sometimes occur and we also observe a positive effect from the vaccination here,” he said. “It cannot be overstated the value of getting vaccinated against COVID-19. I have seen and cared for several women with COVID-19, all of whom were unvaccinated. The great fear of affected women who came to the clinic because of breathing difficulties was terrible.”
Neonatal Outcomes
The analyzes also showed that maternal GDM and preconceptional maternal overweight or obesity increased the risk of adverse fetal and neonatal outcomes (aOR = 1.83; 95% CI, 1.05-3.18). Regardless of GDM status, overweight or obesity were influential factors for maternal (aOR = 1.87; 95% CI, 1.26–2.75) and neonatal outcomes (aOR = 1.81; 95% CI, 1.32– 2.48) compared to underweight or normal weight.
A large majority of newborns have experienced little to no effects from their mothers’ COVID-19 illness, Pecks noted.
“Fortunately, we can reassure the affected women here. However, there are secondary phenomena that can affect the newborn, such as: B. Preterm births due to COVID-19,” Pecks said. “In addition, we confirm with our study that gestational diabetes poses a serious risk to the pregnancy and the fetus, but fortunately it can be easily recognized and treated.”
perspective
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Mary Jane Minkin, MD
The paper by Pecks and colleagues reporting the findings from CRONOS confirms many of the known risk factors for more severe cases of COVID-19 and shows that these risk factors – when combined – can lead to more serious outcomes. We know that pregnancy, obesity and diabetes individually contribute to more severe outcomes in COVID-19 patients.
In fact, one of the first serious complications noted in pregnant women with COVID-19 was the presentation of a severe preeclampsia pattern. We certainly see preeclampsia more frequently in overweight and obese women who have GDM.
So what should we take away from this study? There is still significant resistance among women considering pregnancy or who are pregnant to receive COVID-19 vaccinations. Data like this confirms the potential impact of COVID-19 on pregnancy, and we can explain this data to our patients to encourage immunization. We can also use this data to encourage our overweight or obese patients to lose weight before pregnancy to minimize their risks, which may be especially helpful for our patients who are still trying to wait out the pandemic before they get pregnant.
Mary Jane Minkin, MD
Clinical Professor of Obstetrics and Gynecology, Yale School of Medicine
Healio Women’s Health & OB/GYN Peer Perspective Board Member
Disclosure: Minkin does not report any relevant financial disclosures.
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