Factors associated with maternal hyperglycaemia and neonatal hypoglycaemia after antenatal betamethasone administration in women with diabetes in pregnancy
Open accessAbstract
Aims: Bespoke glycaemic control strategies following antenatal corticosteroids for women with diabetes in pregnancy (DIP) may mitigate hyperglycaemia. This study aims to identify predictive factors for the glycaemic response to betamethasone in a large cohort of women with DIP. Methods: Evaluation of a prospective cohort study of 347 consecutive DIP pregnancies receiving two doses of 11.4 mg betamethasone 24 h apart between 2017 and 2021 and treated with the Pregnancy‐IVI intravenous insulin protocol. Regression modelling identified factors associated with maternal glycaemic time‐in‐range (TIR) and maternal insulin requirements following betamethasone. Factors associated with neonatal hypoglycaemia (glucose <2.6 mmol/L) in infants born within 48 h of betamethasone administration (n = 144) were investigated. Results: The mean maternal age was 31.9 ± 5.8 years, with gestational age at betamethasone of 33.5 ± 3.4 weeks. Gestational diabetes was present in 81% (12% type 1; 7% type 2). Pre‐admission subcutaneous insulin was prescribed for 63%. On‐infusion maternal glucose TIR (4.0–7.8 mmol/L) was 83% [IQR 77%–90%] and mean on‐IVI glucose was 6.6 ± 0.5 mmol/L. Maternal hypoglycaemia (<3.8 mmol/L) was uncommon (0.47 h/100 on‐IVI woman hours). Maternal glucose TIR was negatively associated with indicators of insulin resistance (type 2 diabetes, polycystic ovary syndrome), late‐pregnancy complications (pre‐eclampsia, chorioamnionitis) and the 1‐h OGTT result. Intravenous insulin requirements were associated with type of diabetes, pre‐eclampsia and intrauterine infection, the 1‐h OGTT result and the timing of betamethasone administration. Neonatal hypoglycaemia was associated with pre‐existing diabetes but not with measures of glycaemic control. Conclusion: An intravenous infusion protocol effectively controls maternal glucose after betamethasone. A risk‐factor‐based approach may allow individualisation of therapy.
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“IVI therapy is another option, as demonstrated by Rowe et al. 48,49 They implemented pregnancy-specific IVI protocols that achieved significantly tighter glycaemic control than standard comparators.”
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- Authors
- Rowe, C. W., Rosee, P., Sathiakumar, A., Ramesh, S., Qiao, V., Huynh, J., Dennien, G., Weaver, N., & Wynne, K.
- Affiliations
- John Hunter Hospital (AU)
- University of Newcastle Australia (AU)
- Hunter Medical Research Institute (AU)
- Corresponding author
- Rowe, Christopher W.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2023-11-28
- Volume
- 41
- Issue
- 2
- Pages
- e15262-e15262
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W4389150450
- Cited by
- 6
- References
- 35
- Citations by year
- 2026: 4 · 2025: 2
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetic Medicine (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Figshare (submittedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Keywords
- diabetes in pregnancy, maternal hyperglycemia, neonatal hypoglycemia, betamethasone, antenatal corticosteroids, intravenous insulin infusion, insulin resistance, polycystic ovary syndrome, preeclampsia, chorioamnionitis, oral glucose tolerance test, type 1 diabetes, type 2 diabetes
- MeSH terms
- Adult, Betamethasone, Diabetes Mellitus, Type 2, Female, Fetal Diseases, Glucose, Humans, Hyperglycemia, Hypoglycemia, Infant, Infant, Newborn, Insulin, Pre-Eclampsia, Pregnancy, Pregnancy in Diabetics, Prospective Studies, Diabetes, Gestational, Parturition
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