Diabetes, excess weight up risk of COVID-19 in pregnancy

Diabetes mellitus and overweight or obesity appear to increase susceptibility to COVID-19 among pregnant women, with insulin-dependent gestational diabetes mellitus being associated with the disease, according to data from INTERCOVID.

INTERCOVID enrolled 2,184 pregnant women aged ≥18 years, of which 2,071 (averaged age 30.2 years, 43.4 percent nulliparous) were included in the analyses. Each woman diagnosed with COVID-19 was matched to two women without the infection who were delivering or initiating antenatal care.

In the cohort, 9.4 percent of the women had gestational diabetes mellitus (GDM), 2.6 percent had diabetes, and 43.0 percent were overweight or obese. Pre-existing diabetes contributed to a 94-percent increase in the risk of COVID-19 (risk ratio [RR], 1.94, 95 percent confidence interval [CI], 1.55–2.42). Likewise, there was about a 20-percent risk increase associated with overweight or obesity (RR, 1.20, 95 percent CI, 1.06–1.37) and GDM (RR, 1.21, 95 percent CI, 0.99–1.46).

Of note, the association between GDM and COVID-19 was pronounced among women requiring insulin, whether they were of normal weight (RR, 1.79, 95 percent CI, 1.06–3.01) or overweight or obese (RR, 1.77, 95 percent CI, 1.28–2.45).

Meanwhile, a somewhat stronger association with COVID-19 diagnosis was observed among women with pre-existing diabetes mellitus, whether they were of normal weight (RR, 1.93, 95 percent CI, 1.18–3.17) or overweight or obese (RR, 2.32, 95 percent CI, 1.82–2.97).

The observed associations persisted in sensitivity analyses that were restricted to women with a real-time polymerase chain reaction test or an antigen test in the week before delivery or during the entire pregnancy, including missing variables using imputation or controlling for month of enrolment.