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Rowe CW, Rosee P, Sathiakumar A, Ramesh S, Qiao V, Huynh J, Dennien G, Weaver N, Wynne K. Factors associated with maternal hyperglycaemia and neonatal hypoglycaemia after antenatal betamethasone administration in women with diabetes in pregnancy. Diabet Med 2024; 41:e15262. [PMID: 38017692 DOI: 10.1111/dme.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
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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Affiliation(s)
- Christopher W Rowe
- Department of Endocrinology and Diabetes, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Patrick Rosee
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Angeline Sathiakumar
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Soundarya Ramesh
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Vivian Qiao
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jason Huynh
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Georgia Dennien
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Natasha Weaver
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Katie Wynne
- Department of Endocrinology and Diabetes, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Croker EE, Rowe CW, Mohammad N, Wynne K. Accuracy of Continuous Glucose Monitoring in Pregnancy During Inpatient Acute Glycemic Variability in Women with Type 1 Diabetes Mellitus. J Diabetes Sci Technol 2023; 17:253-255. [PMID: 36146931 PMCID: PMC9846392 DOI: 10.1177/19322968221126995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Emma E. Croker
- Department of Diabetes and Endocrinology,
John Hunter Hospital, New Lambton, NSW, Australia
| | - Christopher W. Rowe
- Department of Diabetes and Endocrinology,
John Hunter Hospital, New Lambton, NSW, Australia
- School of Medicine and Public Health, College
of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW,
Australia
| | - Naeel Mohammad
- Department of Diabetes and Endocrinology,
John Hunter Hospital, New Lambton, NSW, Australia
| | - Katie Wynne
- Department of Diabetes and Endocrinology,
John Hunter Hospital, New Lambton, NSW, Australia
- School of Medicine and Public Health, College
of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW,
Australia
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Rowe CW, Qiao V, Ramesh S, Rosee P, Sathiakumar A, McWhae-Brown S, Griffiths E, Wynne K. Adoption of a pregnancy-specific intravenous insulin protocol (Pregnancy-IVI) at a regional centre has equivalent safety and efficacy outcomes as a tertiary hospital. Diabet Med 2023; 40:e15003. [PMID: 36350295 PMCID: PMC10100034 DOI: 10.1111/dme.15003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Christopher W Rowe
- Department of Diabetes and Endocrinology, John Hunter Hospital, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Vivian Qiao
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Soundarya Ramesh
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Patrick Rosee
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Angeline Sathiakumar
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Sienna McWhae-Brown
- Department of Maternity and Gynaecology, The Maitland Hospital, Maitland, Australia
| | - Eliza Griffiths
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Department of Maternity and Gynaecology, The Maitland Hospital, Maitland, Australia
| | - Katie Wynne
- Department of Diabetes and Endocrinology, John Hunter Hospital, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Dashora U, Levy N, Dhatariya K, Willer N, Castro E, Murphy HR. Reply to Rowe et al Re: Managing hyperglycaemia during antenatal steroid administration, labour and birth in pregnant women with diabetes - an updated guideline from the Joint British Diabetes Society for Inpatient Care Dashora et al. Diabetic Medicine. 2022;39:e14744. Diabet Med 2022; 39:e14844. [PMID: 35420701 DOI: 10.1111/dme.14844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Umesh Dashora
- Conquest Hospital, The Ridge, St Leonards on Sea, Hastings, UK
| | | | - Ketan Dhatariya
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nina Willer
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Erwin Castro
- Conquest Hospital, The Ridge, St Leonards on Sea, Hastings, UK
| | - Helen R Murphy
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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Rowe CW, Wynne K. Re: Managing hyperglycaemia during antenatal steroid administration, labour and birth in pregnant women with diabetes - An updated guideline from the Joint British Diabetes Society for Inpatient Care. Diabet Med 2022; 39:e14848. [PMID: 35429185 PMCID: PMC9324197 DOI: 10.1111/dme.14848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher W. Rowe
- Department of Endocrinology and DiabetesJohn Hunter HospitalNewcastleNSWAustralia
| | - Katie Wynne
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNSWAustralia
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Dashora U, Levy N, Dhatariya K, Willer N, Castro E, Murphy HR. Managing hyperglycaemia during antenatal steroid administration, labour and birth in pregnant women with diabetes - an updated guideline from the Joint British Diabetes Society for Inpatient Care. Diabet Med 2022; 39:e14744. [PMID: 34811800 DOI: 10.1111/dme.14744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/17/2021] [Indexed: 12/27/2022]
Abstract
This article summarises the Joint British Diabetes Societies for Inpatient Care guidelines on the management of glycaemia in pregnant women with diabetes on obstetric wards and delivery units, Joint British Diabetes Societies (JBDS) for Inpatient Care Group, ABCD (Diabetes Care) Ltd. The updated guideline offers two approaches - the traditional approach with tight glycaemic targets (4.0-7.0 mmol/L) and an updated pragmatic approach (5.0-8.0 mmol/L) to reduce the risk of maternal hypoglycaemia whilst maintaining safe glycaemia. This is particularly relevant for women with type 1 diabetes who are increasingly using Continuous Glucose Monitoring (CGM) and Continuous Subcutaneous Insulin Infusion (CSII) during pregnancy. All women with diabetes should have a documented delivery plan agreed during antenatal clinic appointments. Hyperglycaemia following steroid administration can be managed either by increasing basal and prandial insulin doses, typically by 50% to 80%, or by adding a variable rate of intravenous insulin infusion (VRIII). Glucose levels, either capillary blood glucose or CGM glucose levels, should be measured at least hourly from the onset of established labour, artificial rupture of membranes or admission for elective caesarean section. If intrapartum glucose levels are higher than 7.0 or 8.0 mmol/L on two consecutive occasions, VRIII is recommended. Hourly capillary blood glucose rather than CGM glucose measurements should be used to adjust VRIII. The recommended substrate fluid to be administered alongside a VRIII is 0.9% sodium chloride solution with 5% glucose and 0.15% potassium chloride (KCl) (20 mmol/L) or 0.3% KCl (40 mmol/L) at 50 ml/hr. Both the VRIII and CSII rates should be reduced by at least 50% after delivery.
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Affiliation(s)
- Umesh Dashora
- Conquest Hospital, The Ridge, St Leonards on Sea, UK
| | | | - Ketan Dhatariya
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nina Willer
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Erwin Castro
- Conquest Hospital, The Ridge, St Leonards on Sea, UK
| | - Helen R Murphy
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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