Dr Julie Chemmanam
Flinders Medical Centre


Title: Glycaemic Control After Antenatal Corticosteroids In Women With Gestational Diabetes

Authors: Dr Julie Chemmanam1, Dr Bill Jeffries2, Dr Shantha Joseph1,3

Affiliation: 1 Eastern Health, 2 North West Academic Centre, Department of Medicine, The University of Melbourne, Melbourne, Australia.

Abstract Text: 

Antenatal corticosteroids (ACS) are associated with significant reduction in rates of respiratory distress syndrome (RDS). Maternal diabetes mellitus is an independent risk factor for RDS and the need for ACS therapy is thought to be greater in women with diabetes. On the contrary, ACS can cause maternal hyperglycaemia. In the peripartum period, this may be associated with fetal complications including neonatal hypoglycaemia. 
There is no conclusive evidence for the safety and efficacy of ACS in diabetic mothers. Nevertheless, most guidelines recommend that diabetes should not be considered a contraindication for ACS. Further, there is no comprehensive guideline for management of hyperglycaemia in this situation although there are some suggested protocols in literature. Of greater concern is that monitoring and management of hyperglycaemia is often missed due to lack of a set protocol. Our audit was designed to study the existing glycaemic management at Flinders Medical Centre (FMC), of women with gestational diabetes (GDM) receiving ACS.

The blood glucose readings and insulin protocols of consecutive cases of GDM who received ACS and delivered at FMC between 1/1/2015 and 1/1/2016 were analysed for a total of 4 days around the event of the ACS injection.

47 women with GDM received ACS. 30% of these women received isophane insulin at the time of ACS and subsequent correctional Novorapid, 17% had correctional Novorapid alone, while 51% had no specific plan for management of hyperglycaemia. 73% of the recommended blood glucose monitoring was actually performed. 36% of these readings were above the target blood glucose of 6.9 mmol/L. 

ACS for GDM is associated with a significant risk of hyperglycaemia. There is clear need for a protocol and testing of the protocol to define monitoring and management of hyperglycaemia in this group of patients.