BACKGROUND Pregnant women with diabetes are identified as being more vulnerable to the severe effects of COVID-19 and advised to stringently follow social distancing measures. Here we review the management of diabetes in pregnancy before and during the lockdown. METHODS The majority of antenatal diabetes and obstetric visits are provided remotely, with pregnant women attending hospital clinics only for essential ultrasound scans and labour and delivery. On-line resources for supporting women planning pregnancy as well as for self-management of pregnant women with type 1 diabetes (T1D) using intermittent or continuous glucose monitoring (CGM) are provided. Retinal screening procedures, intrapartum care and the varying impact of lockdown on maternal glycaemic control are considered. Alternative screening procedures have for diagnosing hyperglycaemia during pregnancy and Gestational Diabetes (GDM) are discussed. Case histories describe the remote initiation of insulin pump therapy and automated insulin delivery in T1D pregnancy. RESULTS Initial feedback suggests that video consultations are well received and that the patient experiences for women requiring face-to-face visits are greatly improved. As the pandemic eases, formal evaluation of remote models of diabetes education and technology implementation, including women's views, will be important. CONCLUSIONS Research and audit activities will resume and we will find new ways for supporting pregnant women with diabetes to choose their preferred glucose monitoring and insulin delivery.
Managing Diabetes in Pregnancy before, during and after COVID-19.