Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Department of Medicine, Division of Endocrinology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Front Endocrinol (Lausanne). 2021 Jan 13;11:592522. doi: 10.3389/fendo.2020.592522. eCollection 2020.
Pregnant 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.
This 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.
This 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.
This small study demonstrated preliminary safety of the protocol. Enhanced surveillance is necessary for 72 h after initiation of betamethasone.
患有糖尿病的孕妇通常需要早产。产前使用倍他米松可降低围产期发病率和死亡率，但会导致高血糖。主要目的是观察葡萄糖波动，并确定在产前病房使用倍他米松后皮下胰岛素方案的初步安全性。
本回顾性研究纳入了所有因预期早产而接受倍他米松治疗的糖尿病妇女。评估空腹和餐后 2 小时的血糖波动。血糖值≥14mmol/L 或≤3.5mmol/L 分别视为不可接受的高血糖和低血糖。记录前 96 小时的事件。
本研究跨越 52 个月，共纳入 59 名妇女。6 名妇女共发生 11 次明确的低血糖事件，均接受胰岛素治疗，但无胰岛素校正剂量后发生低血糖。未报告严重低血糖事件。17 名妇女在接受倍他米松治疗后 48 小时内几乎均出现高血糖事件（56 次中的 47 次），最常见于餐后（56 次中的 34 次），且 85%的事件发生在餐前血糖值>9mmol/L（34 次中的 29 次）之前。其中 14 名（82.4%）妇女正在接受基础胰岛素治疗。无妊娠期糖尿病患者出现明确的高血糖。
这项小型研究表明该方案具有初步安全性。在开始使用倍他米松后需要进行 72 小时的强化监测。
