Innovations during Covid-19 pandemic for maintaining follow up of a longitudinal pregnancy cohort in India

More than 90% of the prevalence of gestational diabetes mellitus (GDM) occurs in lower-middle income countries. Women from south Asia and southeast Asia are known to have higher risk of incident diabetes post-GDM. However, there are not many longitudinal studies starting from early pregnancy from these populations. The STratification of Risk of Diabetes in Early pregnancy (STRiDE) study recruited 2703 women in early pregnancy between 2016-2019 from 7 centres (3 cities and rural areas) in India. The STRiDE-Follow up study (STRiDE-FUS) aims to do a longitudinal follow-up of this cohort to assess the history of cardio-metabolic disorders (dysglycaemia, hypertension, dyslipidaemia, and cardiovascular disease (CVD)). However, Covid-19 pandemic lockdown imposed significant challenges to establish contact with the participants. Lack of contact could jeopardise long-term follow up, which is essential to avoid selection bias in such longitudinal cohorts. We developed the following strategies to maintain the follow-up rates and utilised these opportunities for supporting these women during the Covid-19 pandemic. A rapid ethical review for a telephone interview and data collection was obtained. With the research associates working from home, we formulated the data collection information on a freely available google form. Teams of research assistants were trained on these data collection forms remotely and formed a WhatsApp group to communicate, share challenges and good practice. The data collected included the self-reported status of their health including diabetes, Covid-19, and CVD. The STRiDE-FUS was able to achieve a response rate of 92.8% through this telephonic data collection (Oct 2020-Oct 2021). The telephonic data collection not only enabled to keep the participants interested in the STRiDE-FUS but also helped to double the uptake rate of postpartum screening than the participation achieved just before the pandemic (127%, p<0.001). This approach was a low-cost, user-friendly innovation that also enabled to update the contact details of the participants which helped subsequent follow-up (significant internal migration due to pandemic). In addition, participants also valued the interaction with the research staff during the pandemic as they had opportunities to ask questions about Covid-19 to allay their anxiety.