Oral Presentation Society of Obstetric Medicine of Australia and New Zealand and Australasian Diabetes in Pregnancy Society Joint Scientific Meeting 2017

Hyperglycaemia associated with antenatal corticosteroid use (#50)

Amy L Harding 1 , Melissa A Franks 2 , Lan Lan 1 , Solomon J Cohney 3 , Christopher J Yates 1
  1. Department of Endocrinology & Diabetes, Western Health, St Albans, Victoria, Australia
  2. Department of Obstetrics & Gynaecology, Western Health, St Albans, Victoria, Australia
  3. Department of Nephrology, Western Health, St Albans, Victoria, Australia

Background: Antenatal corticosteroid treatment for pregnant women at risk of preterm delivery has been documented to reduce the incidence of neonatal respiratory distress syndrome, accelerate foetal lung maturation and reduce perinatal mortality.  Several studies have demonstrated transient hyperglycaemia associated with antenatal corticosteroid use in women with Gestational Diabetes Mellitus (GDM), however the magnitude and duration of hyperglycaemia in each group is yet to be fully determined. International guidelines have recommended that women with GDM receiving antenatal corticosteroids are monitored closely and receive additional insulin, however to date, such protocols have yet to be validated.

Methods:  Pregnant women who were planned to receive 2 doses of antenatal betamethasone 24 hours apart, were enrolled to receive continuous glucose monitoring (iPro2 Medtronic) for 5 days’ duration, commencing 2 days prior to first dose.  Women with GDM were assigned to receive increased doses of insulin following the administration of betamethasone according to a pre-specified protocol.  Peak glucose levels, nadir glucose and median glucose was calculated and compared between women with GDM with those without.  Duration and degree of hyperglycaemia exposure was calculated from area and time under the curve.

Results:  Median peak glucose in those without GDM was 9.8 mmol/L (range 8.1–10.8), compared to 7.6mmol/L in those with GDM treated with insulin as per the pre-specified protocol.  Peak glucose occurred between 08:40hrs and 36:30hrs post 1st dose corticosteroid.  Hyperglycaemic exposure varied considerably in individuals, with median of 16.55mmol/L/hr (range 7.9–90.5) in those without GDM, and was greater than those with treated GDM.  Time exposed to hyperglycaemia 72 hours after first dose of corticosteroid was between 12.5–65.3 hours.

Conclusions:  Exposure to antenatal corticosteroids results in significant hyperglycaemia both in women with GDM and in those without.  A proactive insulin treatment approach in those with GDM may help to reduce hyperglycaemic exposure.