Glucocorticoid-associated maternal hyperglycemia: a randomized trial of insulin prophylaxis.
OBJECTIVE
To study the degree and timing of maternal hyperglycemia following betamethasone therapy in nondiabetic patients and establish a prophylactic dose of insulin.


METHODS
Forty-five patients receiving betamethasone 12 mg i.m. at 7 AM on two consecutive days were randomized to no insulin (n = 20), low-dose insulin (n = 18), and high-dose insulin (n = 7) protocols. Each treatment group received s.c. insulin at 7 AM on the 2 days of betamethasone therapy (20 units NPH/10 units regular, and 40 units NPH/20 units regular, respectively). Capillary plasma glucose measurements were obtained at fasting and 2 h after meals for 3 days. A multivariate normal regression model was used to estimate and compare mean glucose levels.


RESULTS
Eighty-five percent of patients who did not receive insulin exhibited hyperglycemia at levels previously associated with fetal acidosis. Significant differences in mean postprandial plasma glucose levels were found between the no-treatment and insulin groups on days 1 and 2. No significant differences were noted between groups on day 3.


CONCLUSIONS
Transient maternal hyperglycemia occurs in a consistent pattern in nondiabetic patients receiving betamethasone, which can be limited by the concurrent use of insulin. Further studies to assess fetal acidosis in this setting are warranted.
Star
J
J
Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island, USA. jstar@wihri.org
Hogan
J
J
Sosa
M E
ME
Carpenter
M W
MW
D000328:Adult; D001623:Betamethasone / Q000009:adverse effects*; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007231:Infant, Newborn; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced / Q000517:prevention & control*; D011256:Pregnancy Outcome; D012044:Regression Analysis; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control
D001786:Blood Glucose; D005938:Glucocorticoids; D007004:Hypoglycemic Agents; D007328:Insulin; D001623:Betamethasone