<em>Antenatal Corticosteroids and Adverse Pregnancy Outcomes in GDM women- Friend or Foe?</em> — ASN Events
  1. Schedule
  2. Session 5: Peripartum and Neonatal
  3. Antenatal Corticosteroids and Adverse Pregnancy Outcomes in GDM women- Friend or Foe?

Antenatal Corticosteroids and Adverse Pregnancy Outcomes in GDM women- Friend or Foe? (#28)

Catherine Yu 1 2 , Angus Gill 1 2 , Jeff Flack 1 2 3 , Sophie Templer 1 2 , Sarah Abdo 2 3 , Ahmed Hussein 2 3 , Cunjing Li 2 , Ronia Awick 4 , Karen Harris 1 4 5 , Tang Wong 1 2 3
  1. Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
  2. Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
  3. School of Medicine, Western Sydney University, Sydney, NSW, Australia
  4. Maternity and Birthing Unit, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
  5. Obstetrics and Gynaecology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia

 

Objectives:

To assess:

(1) Whether appropriate glycaemic management strategies are implemented in Gestational Diabetes(GDM) women receiving antenatal corticosteroids(ACS).

(2) Neonatal hypoglycaemia(NH) risk in GDM women receiving ACS compared to controls.

(3) The frequency of ACS administration to GDM mothers with term infants, where benefits vs risks are uncertain1.

 

Methods: We conducted a retrospective analysis of consecutive singleton pregnancies in GDM women(ADIPS2014 criteria), receiving ACS at Bankstown-Lidcombe Hospital (Jan2020-December2021). GDM women receiving ACS(GDM-ACS;n=54) were compared to two control groups; normal glucose tolerant women receiving ACS (NGT-ACS;n=50) and, GDM women not receiving ACS(GDM-Control;n=505). Concordance with hyperglycaemia mitigation strategies(BGL monitoring adequacy, endocrine team involvement, ACS timing) & rates of maternal hyperglycaemia and NH were assessed.

 

Results: Of the 54 women in the GDM-ACS group, 7(13.0%) received ACS prior to 9am. 41(75.9%) had BGL assessment prior to ACS, 46(85.2%) had BGL monitoring undertaken ≥4x daily and 47(87.0%) had endocrine involvement during admission. Mild maternal hyperglycaemia(BGL7.8-10mM) occurred in 43(79.6%) and severe hyperglycaemia(BGL≥10mM) in 18(33.3%). Mean total daily dose of insulin increased from 22.1U at baseline to 60.0U in the first 48 hours (paired t-test;p<0.0001).

 

The risk of NH in GDM-ACS women was higher than both NGT-ACS women [32.1% vs 15.8%,OR2.5(95%CI1.2-5.4), p<0.05] and GDM-Controls [32.1%vs9.7%,OR4.4(95%CI2.3-8.4), p<0.0001]. 17(31.5%) GDM-ACS women received ACS after 37 weeks gestation.  Neonates of GDM-ACS women who received ACS at term were at significantly higher risk of hypogylcemia versus GDM-Control women [23.1% vs 8.9%, OR 3.1 (95% CI 1.2-8.4), p<0.05].

 

Discussion: Compared to a prior 2018 audit at our facility, endocrine team involvement in GDM women receiving ACS has increased from 43.4%, to 70.4%, however rates of maternal hyperglycaemia remains high.  Similar to our previous audit, NH was almost 3-fold higher in GDM-ACS compared to NGT-ACS women. Compared to a second control group of GDM women not receiving ACS [GDM-Control] the risk of neonatal hypoglycaemia was 4.7-fold higher in GDM-ACS women. A substantial proportion of GDM-ACS women receive ACS at term. NH was three-fold higher in term GDM-ACS infants control compared to term GDM-Controls.

 

Conclusion:

(1)            Concordance with strategies to mitigate maternal hyperglycaemia and thereby neonatal hypoglycaemia remain suboptimal in GDM women receiving ACS.

(2)            Risk of neonatal hypoglycaemia is significantly higher in GDM-ACS women compared to both NGT-ACS and GDM-Controls groups

(3)             Judicious use of ACS in GDM-women at term should be considered, given the high rates of NH, and controversy regarding risks vs benefits1.

 

  1. 1. Gupta K, Rajagoppal R, King F and Simmons D. Complications of Antenatal corticosteroids in infants born by early term schedule caesarean section, Diabetes Care, 2020.
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