Glucocorticoid-associated maternal hyperglycemia: A randomized trial of insulin prophylaxis

Star, Jami; Hogan, Joseph W.; Sosa, Mary Ellen Burke; Carpenter, Marshall W.

doi:10.1002/1520-6661(200009/10)9:5<273::aid-mfm3>3.0.co;2-n

Cited by 21 publications

(19 citation statements)

References 13 publications

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“…Star et al [8] reported that hyperglycemia were found approximately 3-8 hours following each dose of betamethasone, although levels of plasma glucose were not determined on an hourly basis. In contrast to our subjects, women in their study cohort received a standard hospital diet during ACS treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal maternal glycemic control is necessary during ACS treatment in pregnancies with GDM as well as DM because maternal hyperglycemia is associated with fetal acidosis [3,4]. Several authors have demonstrated maternal glycemic control after the corticosteTime-dependent changes in insulin requirement for maternal glycemic control during antenatal corticosteroid therapy in women with gestational diabetes: a retrospective study [5][6][7][8][9]. However, data on the timedependent changes in insulin requirement during the treatment is limited especially in Japanese women with GDM.…”

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confidence: 99%

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Time-dependent changes in insulin requirement for maternal glycemic control during antenatal corticosteroid therapy in women with gestational diabetes: a retrospective study

et al. 2016

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Abstract. Though recommended for pregnant women at risk of preterm birth to improve perinatal outcomes, antenatal corticosteroid (ACS) treatment can cause maternal hyperglycemia, especially in cases of glucose intolerance. A standardized protocol for preventing hyperglycemia during ACS treatment remains to be established. We herein retrospectively investigated the time-dependent changes in insulin dose required for maternal glycemic control during ACS treatment in gestational diabetes (GDM). Twelve singleton pregnant women with GDM who received 12 mg of betamethasone intramuscularly twice 24 hours apart were included in this analysis. Of those, eight also received ritodrine hydrochloride for preterm labor. The blood glucose levels were maintained at 70-120 mg/dL with continuous intravenous infusion of insulin and nothing by mouth for 48 hours after the first betamethasone administration. After the first dose of betamethasone, the insulin dosage needed for glycemic control gradually increased and reached a maximum (6.6 ± 5.8 units/hr) at 10 hours, then, decreased to 4.1 ± 1.5 units/hr at 24 hours. Similar changes in the insulin requirement were found after the second betamethasone dose (the maximum insulin dosage: 5.5 ± 1.6 units/hr at 9 hours following the second administration). Women treated with ritodrine hydrochloride needed more insulin, than those without ritodrine hydrochloride treatment (130.8 ± 15.0 vs. 76.8 ± 15.2 units/day, respectively, p < 0.05). Our data indicated that the requirement for insulin is highest 9-10 hours after each dose of betamethasone. When GDM is treated with ACS, levels of blood glucose should be carefully monitored, especially in patients treated with ritodrine hydrochloride.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Time-dependent changes in insulin requirement for maternal glycemic control during antenatal corticosteroid therapy in women with gestational diabetes: a retrospective study

et al. 2016

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“…Administration of antenatal steroids, commonly betamethasone, in the setting of preterm labour improves neonatal lung function , but induces significant hyperglycaemia in women with and without diabetes mellitus . This maternal hyperglycaemia, resulting in fetal hyperinsulinaemia, may be the mechanism for the observed subsequent neonatal hypoglycaemia.…”

Section: Introductionmentioning

confidence: 99%

An intravenous insulin protocol designed for pregnancy reduces neonatal hypoglycaemia following betamethasone administration in women with gestational diabetes

et al. 2018

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Aims Marked hyperglycaemia is common following betamethasone administration in women with gestational diabetes (GDM), and may contribute to neonatal hypoglycaemia. Validated protocols to deliver glycaemic stability following betamethasone are lacking. We hypothesized that an intravenous insulin (IVI) protocol for pregnancy‐specific glycaemic targets (Pregnancy‐IVI) would achieve greater at‐target glycaemic control than a generic adult intravenous insulin protocol (Adult‐IVI), and may reduce neonatal hypoglycaemia. Methods A retrospective cohort study of the performance Adult‐IVI and Pregnancy‐IVI following betamethasone in GDM, sequentially implemented at a tertiary hospital, without change in indication for IVI. Cases were identified by electronic record search. Primary outcome was percentage of on‐IVI time with at‐target glycaemia [blood glucose level (BGL) 3.8–7 mmol/l]. Secondary outcomes were time with critical hyperglycaemia (BGL > 10 mmol/l), occurrence of maternal hypoglycaemia (BGL < 3.8 mmol/l), and incidence of neonatal hypoglycaemia (BGL ≤ 2.5 mmol/l) if betamethasone was administered within 48 h of birth. Results The cohorts comprised 151 women (Adult‐IVI n = 86; Pregnancy‐IVI n = 65). The primary outcome was 68% time‐at‐target [95% confidence interval (CI) 64–71%) for Pregnancy‐IVI compared with 55% (95% CI 50–60%) for Adult‐IVI (P = 0.0002). Critical maternal hyperglycaemia (0% vs. 2%, P = 0.02) and hypoglycaemia (2% vs. 12%, P = 0.02) were both lower with Pregnancy‐IVI than Adult‐IVI. Neonatal hypoglycaemia was less common after Pregnancy‐IVI (29%) than after Adult‐IVI (54%, P = 0.03). A multiple logistic regression model adjusting for potential confounders gave an odds ratio for neonatal hypoglycaemia with Pregnancy‐IVI of 0.27 (95% CI 0.10–0.76, P = 0.01). Conclusions An IVI protocol designed for pregnancy effectively controlled maternal hyperglycaemia following betamethasone administration in GDM. This is the first intervention to show a reduction in betamethasone‐associated neonatal hypoglycaemia, linked with optimum maternal glycaemic control.

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“…Blood glucose levels typically start to rise 4-6 h after a betamethasone injection, with the main impact on blood glucose levels occurring in the first 24 h after the injection. [199][200][201] There may be a diminishing effect on blood glucose levels for up to 6 days. The impact of oral steroids on blood glucose levels also needs consideration.…”

Section: Glycaemic Management After Corticosteroid Administrationmentioning

confidence: 99%

ADIPS 2020 guideline for pre‐existing diabetes and pregnancy

Rudland

Price

Hughes

et al. 2020

Aust NZ J Obst Gynaeco

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This is the full version of the Australasian Diabetes in Pregnancy Society (ADIPS) 2020 guideline for pre-existing diabetes and pregnancy. The guideline encompasses the management of women with pre-existing type 1 diabetes and type 2 diabetes in relation to pregnancy, including preconception, antepartum, intrapartum and postpartum care. The management of women with monogenic diabetes or cystic fibrosis-related diabetes in relation to pregnancy is also discussed. E19 V. L. Rudland et al. GUIDELINE DEVELOPMENT AND METHODOLOGY This guideline is a consensus-based guideline, designed to provide practical guidance to clinicians. It was developed with a multidisciplinary writing team including obstetricians, endocrinologists, obstetric physicians, credentialled diabetes educators (CDE), midwives, lactation consultants and accredited practising dietitians (APD) with expertise in diabetes in pregnancy. It had input from both Australian and New Zealand clinicians. The writing group members were drawn from a variety of clinical backgrounds, including practitioners from metropolitan, regional and rural/ remote settings. The guideline did not aim to meet the National Health and Medical Research Council standard for guidelines, and rating quality of evidence or strength of each recommendation was out of scope. There was no funding available and this work was completed on a purely voluntary basis. The literature was reviewed, and each member of the writing group was assigned a section of the guideline to write. Sections were then reviewed by all members, and a consensus of expert opinion was achieved. The guideline was reviewed by the Australasian Diabetes in Pregnancy Society (ADIPS) board, and then widely disseminated throughout Australia and New Zealand for stakeholder review, with feedback from 14 professional organisations and 17 ADIPS members (obstetricians, endocrinologists, midwives, dietitians). The guideline writing group would like to acknowledge the valuable and extensive feedback provided. Each item of feedback was reviewed by the writing group and a consensus decision was made in response to each item of feedback. There are key areas that this guideline does not address: 1. Routine pregnancy care: This guideline specifically addresses issues of pre-existing diabetes and pregnancy. It does not include details of routine pregnancy care. Women with pre-existing diabetes and pregnancy require all the usual preconception, antenatal, peripartum and postnatal care that every other woman requires. This guideline is designed to supplement all the usual guidelines for regular pregnancy care for all women. 2. Social determinants of disease are important contributors to the excess burden of type 2 diabetes in Aboriginal and Torres Strait Islander, Maori and Pasifika women. The relationship between social determinants of disease and disease management is critically important. The complexity of these important issues is beyond the scope of this document and cannot be given due consideration in this already lengthy clinical guid...

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Glucocorticoid-associated maternal hyperglycemia: A randomized trial of insulin prophylaxis

Cited by 21 publications

References 13 publications

Time-dependent changes in insulin requirement for maternal glycemic control during antenatal corticosteroid therapy in women with gestational diabetes: a retrospective study

Time-dependent changes in insulin requirement for maternal glycemic control during antenatal corticosteroid therapy in women with gestational diabetes: a retrospective study

An intravenous insulin protocol designed for pregnancy reduces neonatal hypoglycaemia following betamethasone administration in women with gestational diabetes

ADIPS 2020 guideline for pre‐existing diabetes and pregnancy

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