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Euglycemia after antenatal late preterm steroids: a multicenter, randomized controlled trial.

Ashley N Battarbee1, Yuanfan Ye1, Jeff M Szychowski1

  • 1Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Battarbee, Ye, Szychowski, Casey, and Tita); Departments of Obstetrics and Gynecology (Drs Battarbee, Ye, Szychowski, Casey, and Tita) and Biostatistics (Dr Szychowski), The University of Alabama at Birmingham, Birmingham, AL.

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|March 29, 2022
PubMed
Summary

Maternal glycemic control after late preterm steroid administration did not improve fetal C-peptide levels or reduce neonatal hypoglycemia. This suggests glucose screening and treatment are not beneficial for nondiabetic mothers receiving betamethasone.

Keywords:
betamethasoneglucosehypoglycemialate pretermneonatalpregnancysteroids

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Area of Science:

  • Obstetrics and Gynecology
  • Neonatal Medicine
  • Endocrinology

Background:

  • Late preterm steroid administration (betamethasone) can cause transient maternal and fetal hyperglycemia.
  • This can increase fetal insulin and C-peptide production, raising the risk of neonatal hypoglycemia.
  • The impact of maternal glycemic control in this specific scenario was previously unstudied.

Purpose of the Study:

  • To evaluate the effect of maternal hyperglycemia screening and treatment following late preterm steroid administration.
  • To assess the impact on fetal C-peptide levels and other metabolic markers.

Main Methods:

  • A multicenter randomized trial involving nondiabetic parturients receiving betamethasone between 34 0/7 and 36 5/7 weeks.
  • Intervention group: maternal glucose screening and insulin treatment for hyperglycemia.
  • Control group: expectant management without glucose monitoring or treatment; primary outcome: fetal C-peptide.

Main Results:

  • Most women (82%) in the glycemic control group experienced hyperglycemia.
  • Maternal glycemic control did not significantly alter fetal C-peptide levels (P=.97) or neonatal hypoglycemia rates (49% vs 51%, P=.83).
  • No improvements were observed in other secondary neonatal or maternal outcomes.

Conclusions:

  • Maternal hyperglycemia is common after late preterm betamethasone in nondiabetic women.
  • Maternal glucose surveillance and treatment did not improve fetal metabolic status or neonatal outcomes.
  • Current evidence does not support the routine use of maternal glucose monitoring and treatment in this population.