COVID 19 to complicate Gestational diabetes mellitus:CRONOS Study

Gestational diabetes mellitus is one of the most frequent pregnancy complications with a global prevalence of 13.4% in 2021. Pregnant women with COVID-19 and gestational diabetes mellitus are 3.3 times more likely to be admitted to an intensive care unit compared to women without gestational diabetes mellitus.

The study aimed to investigate whether gestational diabetes mellitus is an independent risk factor for adverse maternal and fetal/neonatal outcomes in pregnant women with COVID-19.

CRONOS study is a registry-based multicentric prospective observational study from Germany and Linz/Austria. Data was collected from a cloud based electronic data platform. A primary combined maternal endpoint was defined as admission to an intensive care unit (including maternal mortality), and/or viral pneumonia, and/or oxygen supplementation. A primary combined fetal/neonatal endpoint was defined as stillbirth >24+0 weeks of pregnancy, and/or neonatal death <7 days postnatal, and/or transfer to a neonatal intensive care unit. Multivariable logistic regression analysis was performed to evaluate the modulating impact of gestational diabetes mellitus on the defined endpoints.

Out of 1,490 women with COVID-19, 9.4% were diagnosed with gestational diabetes mellitus, of these, 42.9% were treated with insulin. In overweight/obese women, however, gestational diabetes mellitus was independently associated with the primary maternal outcome (adjusted odds ratio 2.69). Overweight/obese women with gestational diabetes mellitus requiring insulin treatment were found to have an increased risk for a severe course of COVID-19 (adjusted odds ratio 3.05).

Maternal gestational diabetes mellitus and maternal preconceptional body mass index >25 kg/m2 increased the risk of adverse fetal/neonatal outcome (adjusted odds ratio 1.83). Furthermore, overweight/obesity (irrespective of gestational diabetes mellitus status) were influential factors for the maternal (adjusted odds ratio 1.87) and neonatal primary endpoints (1.81) in comparison to women with underweight or normal weight.

Researchers concluded that gestational diabetes mellitus, combined with periconceptional overweight/obesity, is independently associated with severe maternal course of COVID-19, especially when the mothers require insulin and COVID-19 is diagnosed with or after gestational diabetes mellitus diagnosis. Women with gestational diabetes mellitus and body mass index >25 kg/m2 are a particularly vulnerable group in the case of COVID-19.