Factors Associated with Insulin Usage in Patients with Gestational Diabetes Mellitus Given Antenatal Corticosteroid

Ria Breneli A. Sumampong-Timpac, Maria Honolina S. Gomez

Apr 2025 DOI 10.35460/2546-1621.2024-0012     Access   

Abstract

Introduction: Administration of antenatal corticosteroids (ACS) between 24 and 36 weeks of gestation is recommended to pregnant women at risk of preterm delivery to decrease the risk of respiratory distress syndrome, intra-ventricular hemorrhage and neonatal death. However, it may worsen glycemic profile primarily in those with gestational diabetes mellitus (GDM).

Objective: To determine the effects of ACS on maternal glycemia in Filipino women with GDM and to analyze the factors associated with insulin use or increased insulin requirement.

Methodology: A retrospective study of the medical records of Filipino women with GDM who were admitted and received ACS treatment (betamethasone) between 24- and 36-weeks age of gestation (AOG) for fetal lung maturity from 2017-2019. Clinical characteristics (age, parity, completed ACS dose, AOG at ACS administration and mode of delivery) and glycemic control were retrieved and compared before and after ACS treatment. Data collection began the day or on the day before steroids were given and continued until discharge or delivery.

Results: Included were 42 pregnant women with GDM. Of these, 28 women with GDM were treated by diet alone (Group A) while 14 women with GDM were started on insulin in addition to diet (Group B). After betamethasone therapy was initiated, only three (Group A1; n=3/28) patients had good glycemic control with diet alone and the rest were given insulin treatment (Group A2; n=25/28). In this subpopulation of Group A2, insulin requirement within 24 hours after ACS was at 0.3 units per kg of body weight. There was a steady increase with maximum requirement observed on day 4 and decreased thereafter to 0.33 units per kg of body weight on day 5. For GDM women in Group B, only three maintained their insulin dose (Group B1; n=3/14) while 11 (Group B2; n=11/14) women with GDM previously on insulin, required further increase in insulin from day 1-2 reaching 140% increase in insulin dose on day 2. Thereafter, there was a gradual decrease of insulin dose almost returning to initial dose on day 5.

Insulin initiation was observed among GDM diet-controlled mothers (Group A) who were given ACS therapy at ≥31 weeks age of gestation. Age, parity, family history of diabetes and mode of delivery did not have significant effects on insulin use nor increased insulin requirement. Fasting capillary glucose (FCG) and one-hour post-prandial capillary glucose (PPCG) were elevated within 24 hours after administration of corticosteroid (betamethasone) in 60%-70% of our population. The FCG values remained elevated on day 2-3 in about 70% of patients. While the first hour PPCG was elevated in 85% of patients on day 2 and remained elevated in 70% of women on day 3-4, it reached 53% on day 5. Insulin requirement among Group B2 reached to 140% increase in insulin dose on day 2 followed by a gradual decrease of insulin dose almost returning to initial dose on day 5.

Conclusion: ACS administration caused maternal hyperglycemia in Filipino women with GDM during the first 24 hours and lasting up to five days. Both fasting glucose and post-prandial glucose were elevated, hence intensified monitoring of maternal glucose levels and temporary addition or increase of insulin doses may be necessary. The timing (≥31 weeks AOG) of administration of ACS on GDM women was associated with subsequent insulin initiation but only on patients initially controlled on diet alone.

  1. Men-Jean Lee DG. Antenatal corticosteroid therapy for reduction of neonatal respiratory morbidity and mortality from preterm delivery. Charles J Lockwood, Richard Martin, Vanessa A Barss, eds. UptoDate Inc. Wolters Kluwer; 2018.
  2. Saccone G, Berghella V. Antenatal corticosteroids for maturity of term or near term fetuses: systematic review and meta-analysis of randomized controlled trials. BMJ [Internet]. 2016;355:i5044. Available from: http://dx.doi.org/10.1136/bmj.i5044
  3. Committee on Obstetric Practice. Committee opinion no. 713: Antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol [Internet]. 2017;130(2):e102–9. Available from: http://dx.doi.org/10.1097/AOG.0000000000002237
  4. Kazem M, Hutcheon JA, Joseph KS. A population-based study of antenatal corticosteroid prophylaxis for preterm birth. J Obstet Gynaecol Can [Internet]. 2012;34(9):842–8. Available from: http://dx.doi.org/10.1016/S1701-2163(16)35383-X 
  5. Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes Care [Internet]. 2007;30 Suppl 2 (Supplement_2):S251-60. Available from: http://dx.doi.org/10.2337/dc07-s225 
  6. Walker JD. NICE guidance on diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NICE clinical guideline 63. London, March 2008. Diabet Med. 2008 Sep;25(9):1025-7. doi: 10.1111/j.1464-5491.2008.02532.x. PMID: 19183306.
  7. Kitzmiller JL, Block JM, Brown FM, Catalano PM, Conway DL, Coustan DR, et al. Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care [Internet]. 2008;31(5):1060–79. Available from: http://dx.doi.org/10.2337/dc08-9020 
  8. Schäcke H, Döcke WD, Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther [Internet]. 2002;96(1):23–43. Available from: http://dx.doi.org/10.1016/s0163-7258(02)00297-8
  9. Ha Y, Lee K-H, Jung S, Lee S-W, Lee S-K, Park Y-B. Glucocorticoid-induced diabetes mellitus in patients with systemic lupus erythematosus treated with high-dose glucocorticoid therapy. Lupus [Internet]. 2011;20(10):1027–34. Available from: http://dx.doi.org/10.1177/0961203311402246 
  10. Yildirim Y, Tinar S, Oner RS, Kaya B, Toz E. Gestational diabetes mellitus in patients receiving long-term corticosteroid therapy during pregnancy. J Perinat Med [Internet]. 2006;34(4):280–84. Available from: http://dx.doi.org/10.1515/JPM.2006.053 
  11. Miracle X, Renzo D, Stark GC, Fanaroff A, Carbonell-Estrany A, Saling X. Coordinators of world association of perinatal medicine prematurity working group. Guideline for the use of antenatal corticosteroids for fetal maturation. J Perinat Med. 2008;36:191–6. 
  12. Itoh A, Saisho Y, Miyakoshi K, Fukutake M, Kasuga Y, Ochiai D, et al. Time-dependent changes in insulin requirement for maternal glycemic control during antenatal corticosteroid therapy in women with gestational diabetes: a retrospective study. Endocr J [Internet]. 2016;63(1):101–4. Available from: http://dx.doi.org/10.1507/endocrj.EJ15-0482
  13. Kakoulidis I, Ilias I, Linardi A, Milionis C, Michou A, Koukkou E. Glycemic profile assessment during betamethasone administration in women with gestational diabetes mellitus. Diabetes Metab Syndr [Internet]. 2019;13(1):214–5. Available from: http://dx.doi.org/10.1016/j.dsx.2018.08.001
  14. Ramírez-Torres MA, Pérez-Monter SE, Espino y Sosa S, Ibargüengoitia-Ochoa F. Effect of betamethasone in blood glucose levels in pregnant diabetic women at risk of preterm birth. Ginecol Obstet Mex. 2011;79(9):565–71.
  15. Kalra S, Kalra B, Gupta Y. Glycemic management after antenatal corticosteroid therapy. N Am J Med Sci [Internet]. 2014;6(2):71–6. Available from: http://dx.doi.org/10.4103/1947-2714.127744
  16. Standards of medical care in diabetes. Diabetes Care. 2018;41:S7–12.
  17. Kreiner A, Gil K, Lavin J. The effect of antenatal corticosteroids on maternal serum glucose in women with diabetes. Open J Obstet Gynecol [Internet]. 2012;02(02):112–5. Available from: http://dx.doi.org/10.4236/ojog.2012.22021
  18. Mathiesen ER, Christensen A-BL, Hellmuth E, Hornnes P, Stage E, Damm P. Insulin dose during glucocorticoid treatment for fetal lung maturation in diabetic pregnancy: test of an algorithm [correction of analgorithm]. Acta Obstet Gynecol Scand [Internet]. 2002;81(9):835–9. Available from: http://dx.doi.org/10.1034/j.1600-0412.2002.810906.x
  19. Barbour LA, McCurdy CE, Hernandez TL, Kirwan JP, Catalano PM, Friedman JE. Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes. Diabetes Care [Internet]. 2007;30 Suppl 2 (Supplement_2):S112-9. Available from: http://dx.doi.org/10.2337/dc07-s202 .
  20. Altinova AE, Toruner F, Bozkurt N, Bukan N, Karakoc A, Yetkin I, et al. Circulating concentrations of adiponectin and tumor necrosis factor-alpha in gestational diabetes mellitus. Gynecol Endocrinol [Internet]. 2007;23(3):161–5. Available from: http://dx.doi.org/10.1080/09513590701227960 .
  21. Bakiner O, Bozkirli E, Ozsahin K, Sariturk C, Ertorer E. Risk factors that can predict antenatal insulin need in gestational diabetes. J Clin Med Res [Internet]. 2013;5(5):381–8. Available from: http://dx.doi.org/10.4021/jocmr1515w
  22. Wong VW, Jalaludin B. Gestational diabetes mellitus: who requires insulin therapy?: GDM: who requires insulin therapy? Aust N Z J Obstet Gynaecol [Internet]. 2011;51(5):432–6. Available from: http://dx.doi.org/10.1111/j.1479-828X.2011.01329.x

Articles related to the one you are viewing

There are currently no results to show, please try again later

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.