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.
Diabet Med. 2024 Feb;41(2):e15262. doi: 10.1111/dme.15262. Epub 2023 Nov 28.
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.
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.
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.
An intravenous infusion protocol effectively controls maternal glucose after betamethasone. A risk-factor-based approach may allow individualisation of therapy.
对于患有妊娠糖尿病（DIP）的女性，在使用产前皮质激素后采用定制的血糖控制策略可能有助于降低血糖水平。本研究旨在确定接受大剂量地塞米松治疗的 DIP 孕妇中，与 betamethasone 血糖反应相关的预测因素。
对 2017 年至 2021 年间连续 347 例接受 2 次 11.4mg 倍他米松治疗（每 24 小时 1 次）的 DIP 妊娠患者进行前瞻性队列研究，并采用妊娠-IVI 静脉内胰岛素方案进行治疗。回归模型确定了与 betamethasone 后母体血糖时间范围（TIR）和母体胰岛素需求相关的因素。对接受 betamethasone 治疗后 48 小时内出生的 144 例婴儿（低血糖<2.6mmol/L）的新生儿低血糖（血糖<2.6mmol/L）相关因素进行了调查。
母亲的平均年龄为 31.9±5.8 岁，betamethasone 时的孕龄为 33.5±3.4 周。81%（12%为 1 型；7%为 2 型）患有妊娠糖尿病。63%的患者在入院前开始皮下注射胰岛素。输注过程中母体血糖 TIR（4.0-7.8mmol/L）为 83%[IQR 77%-90%]，平均 IVI 血糖为 6.6±0.5mmol/L。母体低血糖（<3.8mmol/L）较为少见（每 100 个 IVI 女性小时 0.47 小时）。母体血糖 TIR 与胰岛素抵抗指标（2 型糖尿病、多囊卵巢综合征）、晚期妊娠并发症（子痫前期、绒毛膜羊膜炎）和 1h OGTT 结果呈负相关。静脉内胰岛素需求量与糖尿病类型、子痫前期和宫内感染、1h OGTT 结果和 betamethasone 给药时间有关。新生儿低血糖与原有糖尿病有关，但与血糖控制措施无关。
静脉输注方案可有效控制 betamethasone 后母体血糖。基于危险因素的方法可能允许个体化治疗。
