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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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