Aims:
The prevalence of gestational diabetes (GDM) is increasing due to a combination of factors that include revised diagnostic criteria, increasing prevalence of obesity and advanced maternal age of pregnant women. Women with gestational diabetes at risk of threatened preterm delivery or planned for elective preterm delivery are given antenatal steroids (ANS) to avoid respiratory distress syndrome (RDS). Maternal diabetes mellitus is an independent risk factor for RDS and the need for ANS therapy is thought to be greater in women with diabetes. However, ANS can cause maternal hyperglycaemia and in the peripartum period, this may be associated with fetal complications including neonatal hypoglycaemia. Our audit was designed to explore the obstetric and neonatal outcomes in women with gestational diabetes (GDM) receiving ANS in Flinders Medical Centre (FMC).
Methods:
Case notes of all women with GDM who received ACS and delivered at FMC between 1/1/2015 and 1/1/2016 were analysed
Results:
47 women with GDM received ACS during this period. Maternal hyperglycemia was noted in a significant proportion of patients. 39% of the mothers had a peak BSL ≥10 mmol/L. Neonatal hypoglycaemia was observed in 40% of babies born to these mothers. 30% of babies needed admission to the neonatal intensive care unit and 14% of babies received antibiotic therapy for neonatal sepsis. 32% of babies born to these mothers developed neonatal jaundice.
Conclusions:
ANS treatment is associated with a significant risk of maternal hyperglycaemia and neonatal consequences in women with GDM, even among those who are on non-pharmacological management with diet and exercise. A clear protocol for monitoring and managing anticipated maternal hyperglycemia is needed in this group of patients.