SEQC Spanish Society of Laboratory Medicine

Approximately 12% of pregnant women in Spain have gestational diabetes mellitus, a prevalence that has increased in recent years due to various factors, including a higher rate of obesity in the population and the older age of pregnant women.

Gestational diabetes mellitus is associated with various complications such as increased risk of pre-eclampsia, polyhydramnios (excessive accumulation of amniotic fluid), macrosomia, increased perinatal mortality, foetal hypertrophic cardiomyopathy, neonatal respiratory problems, or metabolic complications in the neonate such as the presence of hypoglycaemia, hyperbilirubinemia, hypocalcaemia, or polycythaemia. In addition, if the pregnant woman has sustained hyperglycaemia during organogenesis, the risks of having a miscarriage and congenital anomalies increase. Treatment of patients with gestational diabetes mellitus can reduce the risk of developing these complications.

Gestational diabetes is just one of the pathologies or conditions that can affect pregnant women. In fact, Dr Blanca Montero San Martín, member of the Residents and Young Scientists Group of the Spanish Society of Laboratory Medicine and of the Clinical Laboratory of the Hospital Universitari Arnau de Vilanova, Lleida, notes that as well as an increase in gestational diabetes mellitus due to the increase in maternal age, a higher prevalence of Down syndrome has also been observed, with 1 case every 450 live births. Likewise, other aneuploidies with a high prevalence are trisomy of chromosome 13 (Patau syndrome) and trisomy of chromosome 18 (Edwards syndrome) with a prevalence of around 2.25 cases per 10,000 and 6.86 per 10,000, respectively.

For this reason, with the aim of raising awareness of the importance of pregnancy as a clinical condition of major importance given the numerous metabolic changes that take place and possible associated pathologies, the II Interhospital Conference 'Approach to pregnant women in a multidisciplinary team: the importance of the Clinical Laboratory’ was held, organized by the Residents and Young Scientists Group of the Spanish Society of Laboratory Medicine (SEQC^ML), with the collaboration of the Spanish Society of Gynaecology and Obstetrics (SEGO), the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC ), and the Commission for Prenatal Diagnosis and Commission for Biological Magnitudes related to Medical Emergencies of the SEQC^ML.

Dr Montero explained that these virtual sessions, which were held thanks to the collaboration of all the participants, maintained the initial program from April 2020 before SARS-CoV-2 invaded our laboratories and our lives. They emphasized the need for and benefits of multidisciplinary teams in the healthcare field, and for this reason they included speakers specialized in Clinical Analysis, Microbiology, and Gynaecology, all members of the main corresponding national scientific societies.

Similarly, Dr Alex Larruzea, from the Clinical Analysis Service of the Mollet Health Foundation, stated that the objective of the conference was to acquire knowledge about the approach to pregnancy from a multidisciplinary approach. For this reason, topics such as gestational diabetes, thyroid disease, gestation from a microbiological point of view, aneuploidy screening, pre-eclampsia, and the importance of the laboratory at the precise moment of delivery were discussed. For example, the taking and handling of samples of the foetal shell and cord is of vital importance when it comes to giving reliable and real results of the condition of the foetus. For this, the laboratory must play an active role and collaborate with the clinical team by providing training and advice on the appropriate way to process this type of sample.

Likewise, since approximately 3% of newborns have some type of congenital anomaly and a quarter of these are chromosomopathies, these were also analysed within the framework of the Conference.

The sessions also featured a presentation of clinical cases, which generated debate to reinforce the knowledge covered in each session, emphasizes Dr Larruzea, who also highlighted the opportunity that this gathering offered to residents and young adjuncts to participate by presenting a session in public , in this case online, and the importance of being able to discuss this in a multidisciplinary forum, with health professionals from both different medical specialties and different geographical areas.

Role of the clinical laboratory professional in the multidisciplinary team

A multidisciplinary approach and coordination between various professionals in the care of pregnant women is especially important. According to Dr Montero, the benefits of the multidisciplinary approach in any pathology have been widely demonstrated. Contact between different clinical professionals favours an exchange of points of view, giving rise to the creation of new work algorithms that translate into an improvement in patient diagnosis, which implies a decrease in time, and an improvement in the management of demand and in the treatment received.

In this context, according to this expert, a laboratory professional should be a member of the multidisciplinary team for the care of pregnant women, as they can provide knowledge about the tests carried out, which contributes to the diagnosis and monitoring of possible pathologies.

Similarly, Dr Larruzea considers that in order to reach a correct diagnosis of each of the pathologies or special situations of pregnant women, the laboratory professional must advise the clinical team in every one of these situations, advising both when taking biological samples and in the different action protocols and with regards to the various possible test results.

It is clear that the laboratory professional is involved in a wide variety of aspects throughout the progression of a woman's pregnancy: they help in monitoring of the thyroid and gestational diabetes, collaborate in genetic tests to detect the most frequent aneuploidies, monitor all the microbiological aspects, and participate in the correct processing and reporting of the tests that can be performed at the time of delivery. In addition, the consulting and advisory function of the laboratory professional in a hospital's clinical team is very important when requesting the corresponding tests, interpreting the results, and establishing the protocols for action.

This applies in the case of gestational diabetes mellitus in which laboratory professionals must actively participate, from the control of preanalytical conditions in which the various samples are extracted, to management of the demand for tests and validation of the test results. Laboratory professionals must take part in the design of the different algorithms and in the investigation of new analytical methodologies. Recently, mass spectrometry-based methods have been developed in which differences in metabolic profiles can be observed in patients with gestational diabetes mellitus compared to healthy people; they can also distinguish pregnant women who will be normoglycemic after pregnancy from those who will suffer Type II postpartum diabetes mellitus, in the opinion of Dr Montero.