Glukosemessung mit dem kontinuierlich messenden Glukosesensor CGMS® bei stoffwechselgesunden Schwangeren während Betamethasontherapie zur fetalen Lungenreifeinduktion

Abstract

The object of this study was to evaluate the effect of betamethasone therapy on maternal glucose levels, to observe the incidence of ketoacidosis and gestational diabetes as well as to judge fetal outcome. 26 patients underwent measurement with the CGMS for at least 72-hour. Morning urine was examined for ketones and glucose, venous blood was drawn from a hand vein for blood gas measurements. At a minimum of seven days after the last betamethasone treatment, an oral glucose tolerance test was performed to exclude gestational diabetes. For fetal outcome weight, body length, head circumference, APGAR and pH of umbilical cord blood were determined. All patients showed transient hyperglycaemia from day 1 to day 2 with normoglycaemia on day 3 (mean +/- SD: 129.6 +/- 20 mg/dL on day 1, 127.1 +/- 17.7 mg/dL on day 2, 96.7 +/- 12.9 mg/dL on day 3, and 91.3 +/- 17.8 mg/dL on day 4). There was a significant fall (p < 0.01) of the mean glucose levels between day 1/3, day 1/4, day 2/3, day 2/4. Neither acidosis (pH < 7.35) nor clinically relevant BE/lactate shifts were seen. Ketonuria was detected in 30 % of the patients before betamethasone, rose to 50 % (on day 1), fell to 24 % (on day 2), and 6 % (on day 3). One week later one patient (4 %) was diagnosed as having gestational diabetes, while four (17 %) showed impaired glucose tolerance. Fetal outcome showed no significant difference compared to the average of the Virchow Klinikum. Pregnant patients have high glucose measurements for two days during betamethasone therapy. No maternal acidosis and no diabetic delayed metabolic effects were seen, and fetal outcome showed good results. A prophylactic use of insulin is not generally needed in healthy women.