Maternal and neonatal glycaemic control after antenatal corticosteroid administration in women with diabetes in pregnancy: A retrospective cohort study
Open accessAbstract
Objective: To describe maternal and neonatal glycaemic control following antenatal corticosteroid administration to women with diabetes in pregnancy. Design: Retrospective cohort study Setting: A tertiary hospital in Auckland, New Zealand Population: Women with diabetes in pregnancy who received antenatal corticosteroids from 2006–2016. Methods: Corticosteroid administration, maternal and neonatal glycaemia data were retrieved from electronic patient records. Demographic data were downloaded from the hospital database. Relationships between variables were analysed using multivariate analysis. Main outcome measures: Maternal hyperglycaemia and neonatal hypoglycaemia Results: Corticosteroids were administered to 647 of 7317 of women with diabetes (8.8%) who gave birth to 715 babies. After an initial course of corticosteroids, 92% and 52% of women had blood glucose concentrations > 7 and > 10 mmol/L respectively. Median peak blood glucose concentration of approximately 10 mmol/L occurred 9 hours after corticosteroid administration and hyperglycaemia lasted approximately 72 hours. Thirty percent of women gave birth within 72 hours of the last dose of corticosteroids. Babies of women who were hyperglycaemic within 24 hours of birth were more likely to develop hypoglycaemia (< 2.6 mmol/L, OR 1.51 [95% CI 1.10–2.07], p = 0.01) and severe hypoglycaemia (≤ 2.0 mmol/L, OR 2.00 [95% CI 1.41–2.85], p < 0.0001) than babies of non-hyperglycaemic mothers. There was no association between maternal glycaemia within 7 days of the last dose of corticosteroids and neonatal hypoglycaemia. Conclusions: Hyperglycaemia is common in women with diabetes in pregnancy following antenatal corticosteroid administration. Maternal hyperglycaemia in the 24 hours prior to birth is associated with increased risk of neonatal hypoglycaemia. Limitations included the retrospective study design, so that not all data were available for all women and babies and the glucose testing schedule was variable.
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In pregnancy, the baseline insulin-resistant state amplifies glucocorticoid effects, explaining the dramatic increases in insulin requirements and heightened risk of severe decompensation.
“In pregnancy, the baseline insulin‐resistant state amplifies GC effects, explaining the dramatic increases in insulin requirements and heightened risk of severe decompensation.”
From A systematic review of glucocorticoid use in type 1 diabetes: Glycaemic effects and clinical management strategies (2026) · cites this paper as [45]
The Results (Maternal glycaemic control; page not indicated) report an approximately 80% increase in insulin dose after antenatal corticosteroids among women already receiving insulin. The paper does not establish that baseline pregnancy-related insulin resistance amplifies glucocorticoid effects or that this mechanism raises the risk of severe maternal decompensation. (LLM, conf=0.86)
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- Authors
- Tuohy, J. F., Bloomfield, F. H., Crowther, C. A., & Harding, J. E.
- Affiliations
- University of Auckland (NZ)
- Corresponding author
- Harding, Jane E.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-02-18
- Volume
- 16
- Issue
- 2
- Pages
- e0246175
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7891747
- OpenAlex
- W3129369166
- Cited by
- 36
- References
- 29
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 7 · 2023: 5 · 2022: 12 · 2021: 3
- FWCI
- 6.12
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- ResearchSpace (University of Auckland) (submittedVersion, cc-by)
- Funders
- LOTTERIES HEALTH RESEARCH (190606-002467)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- antenatal corticosteroids, diabetes in pregnancy, maternal hyperglycemia, neonatal hypoglycemia, glycemic control, preterm birth, maternal blood glucose
- MeSH terms
- Glycemic Control, Adrenal Cortex Hormones, Adult, Female, Humans, Hyperglycemia, Infant, Newborn, Mothers, Pregnancy, Retrospective Studies, Cohort Studies, Diabetes, Gestational
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