Hadid Dima, Correia Rebecca H, McDonald Sarah D, Darling Elizabeth K, Kirkwood David, Jones Aaron, Carruthers Andrea, Kuyvenhoven Cassandra, Howard Michelle, Greyson Devon, Kandasamy Sujane, Vanstone Meredith
Department of Family Medicine, McMaster University, Hamilton, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
PLoS One. 2024 Dec 27;19(12):e0315983. doi: 10.1371/journal.pone.0315983. eCollection 2024.
Gestational diabetes mellitus (GDM) is a common medical complication of pregnancy that leads to adverse outcomes for both infants and pregnant people. Early detection and treatment can mitigate these negative outcomes. The COVID-19 pandemic strained healthcare and laboratory services, including GDM screening programs. Adapted GDM screening guidelines were introduced in many jurisdictions. This study examined changes in uptake, modality, and experiences of GDM screening in Ontario, Canada during the COVID-19 pandemic.
This convergent mixed-method study involved a population-based retrospective cohort analysis of Ontario-based health administrative data to describe and compare gestational diabetes screening rates among 85,228 individuals with live, in-hospital births between January 1-March 31 before (2019) and during the COVID-19 pandemic (2021 and 2022). Descriptive analyses were conducted for GDM screening pathways aligning with usual and pandemic-adapted screening guidance. Qualitative descriptive interviews were conducted about experiences and decision-making of GDM screening with 43 Ontario residents who gave birth between May 2020 and December 2021. Data were integrated during the design and interpretation phases.
There were small but significant increases in GDM screening during the pandemic; likelihood of screening completion using any modality increased in 2021 and 2022 compared to 2019. Testing modality shifted; the alternate screening strategies introduced during COVID-19 were adopted by clinicians. Interview participants perceived GDM screening to be important and obligatory but accompanied by a degree of stress about potential COVID-19 exposure.
Despite health system challenges experienced in Ontario during the COVID-19 pandemic, GDM screening rates increased in the study population, demonstrating the success of adapted GDM screening guidelines. Decisions about screening modalities were driven by clinician expertise, and interview participants were satisfied to provide informed consent to these recommendations.
妊娠期糖尿病（GDM）是一种常见的妊娠并发症，会给婴儿和孕妇带来不良后果。早期检测和治疗可以减轻这些负面结果。2019年冠状病毒病（COVID-19）大流行给包括GDM筛查项目在内的医疗保健和实验室服务带来了压力。许多司法管辖区都出台了适应性GDM筛查指南。本研究调查了加拿大安大略省在COVID-19大流行期间GDM筛查的接受情况、方式和体验的变化。
这项聚合性混合方法研究包括对安大略省卫生行政数据进行基于人群的回顾性队列分析，以描述和比较2019年1月1日至3月31日（COVID-19大流行前）以及COVID-19大流行期间（2021年和2022年）85228例在医院顺产的个体的妊娠期糖尿病筛查率。对符合常规和大流行适应性筛查指南的GDM筛查途径进行描述性分析。对2020年5月至2021年12月期间在安大略省分娩的43名居民进行了关于GDM筛查体验和决策的定性描述性访谈。在设计和解释阶段对数据进行整合。
大流行期间GDM筛查有小幅但显著的增加；与2019年相比，2021年和2022年使用任何方式完成筛查的可能性增加。检测方式发生了变化；临床医生采用了COVID-19期间引入的替代筛查策略。访谈参与者认为GDM筛查很重要且是必要的，但同时对潜在的COVID-19暴露感到一定程度的压力。
尽管安大略省在COVID-19大流行期间面临卫生系统挑战，但研究人群中的GDM筛查率有所提高，这表明适应性GDM筛查指南取得了成功。筛查方式的决策由临床医生的专业知识驱动，访谈参与者对为这些建议提供知情同意感到满意。
