Abstract
AimsPregnant women with diabetes often require preterm delivery. Antenatal betamethasone reduces perinatal morbidity and mortality, but induces hyperglycemia. The primary objective was to observe glucose excursions and determine the preliminary safety of a protocol for subcutaneous insulin following betamethasone administration in an antenatal ward.Material and MethodsThis retrospective study included all women with diabetes who received betamethasone due to anticipated preterm delivery. Glucose excursions were evaluated in the fasting state and 2-h postprandial. Blood glucose values ≥14mmol/L or ≤3.5mmol/L were regarded as unacceptable hyper- and hypoglycemia respectively. Events over the first 96 h were documented.ResultsThis study spanned 52 months and included fifty-nine women. Eleven episodes of defined hypoglycemia occurred in six women, all receiving insulin therapy, but none after a corrective dose of insulin. No serious hypoglycemic incident was reported. Seventeen women experienced hyperglycemic incidents almost entirely (47/56) within 48 h of betamethasone administration, most often postprandially (34/56) and in 85% of episodes, preceded by pre-prandial values >9 mmol/L (29/34). 14 (82.4%) of these women were receiving background insulin therapy. No case with gestational diabetes encountered defined hyperglycemia.ConclusionsThis small study demonstrated preliminary safety of the protocol. Enhanced surveillance is necessary for 72 h after initiation of betamethasone.
Highlights
Eleven episodes of defined hypoglycemia occurred in six women, all receiving insulin therapy, but none after a corrective dose of insulin
Enhanced surveillance is necessary for 72 h after initiation of betamethasone
The study population included all such pregnancies that received a course of antenatal betamethasone (12 mg IM repeated once after 24 h) and were managed according to the local protocol for preprandial corrected subcutaneous insulin (Figure 1)
Summary
The percentage of adult women who are overweight increased from 29.8% in 1980 to 38% in 2013 [1]. In South Africa, more than a third of women are considered obese, and trends of obesity in this population have mirrored the rest of the world [1, 2]. The pregnant population is heavier and older than before [3]. Maternal obesity increases adverse pregnancy outcomes such as hypertensive disorders, gestational diabetes, surgical complications, as well as fetal and neonatal complications [4]. The prevalence of diabetes in pregnancy is about 16.9% globally [5], being the most common medical disorder of pregnancy [6]
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