E-Poster 63rd Endocrine Society of Australia Annual Scientific Meeting 2020

Evaluation of maternal and neonatal outcomes in patients with gestational and pre-gestational diabetes receiving antenatal corticosteroids (#100)

Chelsea Tan 1 , Debra Renouf 1
  1. Peninsula Health , Frankston, Victoria , Australia

Background 

Patients with gestational and pre-gestational diabetes receiving antenatal corticosteroids are at an increased risk of developing hyperglycaemia, predisposing to neonatal hypoglycaemia.1-3 The use of antenatal corticosteroids in this obstetric subpopulation has not been well studied.4,5

Methods 

We conducted a single-centre retrospective analysis of 103 obstetric patients with gestational and pre-gestational diabetes who received antenatal corticosteroids. The primary aim of our study was to evaluate maternal and foetal outcomes in relation to antenatal corticosteroid use, with a focus on neonatal hypoglycaemia, to rationalise the use of antenatal corticosteroids. 

Results 

The major maternal complications were pre-eclampsia (11.7%), preterm premature rupture of membranes (10.7%) and postpartum haemorrhage (9.7%). There were 49 cases (43.8%) of neonatal hypoglycaemia. 26 cases (53.1%) required dextrose infusions. 60% of neonates born at 34 to 36+6 weeks had hypoglycaemia, of which 40% were emergency Caesarean sections. 33.4% of neonates born at 37 to 38+6 weeks had hypoglycaemia, whereby 89.3% were, conversely, elective Caesarean sections. Neonates with hypoglycaemia reached high APGAR scores at 5 minutes of birth at a slower rate (p<0.01). Comparisons between neonates with and without hypoglycaemia showed no significant difference in the rates of neonates with low birth weight (p = 0.46) and macrosomia (p = 0.09). Neonatal hypoglycaemia was associated with a significant increase in special care nursery admissions (p<0.01), and a trend towards increased length of stay (p = 0.31) and tertiary transfers (p = 0.10).

Conclusion 

Neonatal hypoglycaemia remains a concerning potential adverse outcome of antenatal corticosteroid use. Larger studies are required to inform the use of antenatal corticosteroids in patients with gestational and pre-gestational diabetes, especially in late preterm and term gestations. At current, the use of antenatal corticosteroids in late preterm and term gestations in patients with diabetes should be individualised and should involve careful planning in the peripartum period.

 

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