The pathophysiological implications of SARS-Cov-2 infection for human pregnancy and diabetes
As comprehensively summarized by the authors, the prognosis of COVID-19 is related to several factors including platelet activation and increased proinflammatory cytokine release, which is associated with worsening metabolic control, poor disease progression and consequently poor pregnancy outcomes . Noteworthy, SARS-Cov-2 infection may also negatively affect insulin secretion due to direct effects on β-cell function possibly leading to new onset or exacerbation of the disease . This is particularly important for pregnant patients, as even physiologic pregnancy represents a metabolic stress situation associated with a higher degree of insulin resistance . The described pathophysiologic changes, associated with SARS-Cov-2 infection, have major implications for mothers (e.g. hyperglycemia, hypoxemia, thrombosis or preeclampsia) and potential implications for offspring health as well (e.g. due to transgenerational effects caused by fetal programming and preterm delivery) .
The implications of COVID-19 pandemic for screening and diagnosis of gestational diabetes mellitus (GDM)
It is challenging to uphold GDM screening and diagnosis standards while there is a purpose to limit as possible in-person contact in order to reduce the risk of exposure and dissemination of SARS-Cov-2. Consequently, several health care authorities modified their recommendations for GDM screening and testing during the COVID-19 pandemic. Fasting plasma glucose (FPG), glycated haemoglobin A1c and random plasma glucose were discussed as alternative screening strategies to universal testing by use of oral glucose tolerance tests (OGTT) . In this context it should be mentioned that screening by FPG has the advantage of being cheap and less time consuming . Moreover, data from the HAPO (Hyperglycemia and Adverse Pregnancy Outcome) study showed that FPG is sufficient to identify over 50% of all cases if the IADPSG (International Association of Diabetes in Pregnancy Study Groups) criteria were used for GDM classification  and recent studies found that fasting hyperglycaemia is associated with a more severe metabolic phenotype of GDM . The possible advantages of FPG screening (i.e., being cheap, simple and easily to obtain as well as its ability to characterize patients with particularly high risk) may be of major relevance during the actual health care crisis. In addition, FPG can be combined with other risk factors in clinical prediction models, which can further help to reduce the number of more time consuming examinations .
The assessment of optimal treatment strategies and the role of digitalized medicine in the global COVID-19 pandemic
Eberle et al. clearly summarized the potential advantages of “digital care” in the treatment of pregnancies with diabetes . For sure, digitalized medicine will gain more and more importance, especially in the treatment of diabetes. For example, modern real-time continuous glucose monitoring systems (rt-CGMS) enable patients to digitally share their glucose profiles with obstetricians and diabetologists, providing novel opportunities for telemetric interventions. Of note, CGM was recently shown to be effective for pregnant women with type 1 diabetes  and research on women with GDM is ongoing .