The Effect of Steroids on Maternal Glucose Levels
Condition: Gestational Diabetes
MeSH terms: Diabetes, Gestational
Study type: Observational

Summary: 
      This study will look at blood sugar levels in pregnant women who have been given a
      glucocorticoid (steroid) medication to enhance fetal lung maturity. The findings will help
      determine the likelihood, predictive value, adverse effects, response of patients diagnosed
      with gestational diabetes and time course of blood sugar elevation following steroids.
    

Detailed description: 
      Few studies have examined the effects on maternal glucose levels from corticosteroids, which
      are given during some complicated pregnancies to enhance fetal lung maturity when early
      delivery is expected. The applicability of these studies is limited by the presence of
      confounding factors and low numbers of participants (ranging between 7 and 50). Two relevant
      studies are by Mastrobiattista at al and Gurbuz et al. These studies had 7 and 40 subjects
      respectively, and studied the change in maternal 1-hour glucose tolerance tests following
      administration of steroids for fetal lung maturity. The 1-hour tests involve a standard oral
      glucose challenge and are used to screen for gestational diabetes; thus, they may not reflect
      the changes in circulating glucose levels from typical sources of glucose (such as meals)
      anticipated with steroid administration. Both studies showed a change in the results of
      glucose tolerance testing and concluded that screening for gestational diabetes should be
      delayed at least 72 hours to 1 week after completion of the steroid course. Neither study
      looked at maternal glucose values within the first 48 hours of giving the first dose of
      steroids, and neither addressed whether diabetes could be diagnosed alternatively by the
      maternal glucose response within the first 48 hours following steroid administration.

      It has been the investigator's clinical observation that glucose values may be highest during
      those first 48 hours. Another study looked at the effect of various doses of insulin on the
      degree of hyperglycemia for the first 3 days following steroid administration and showed
      increases in glucose values even in the insulin-treated. Unfortunately, some subjects in that
      study had concurrent treatment with another agent known to cause hyperglycemia.

      No standards of care exist to guide whether to monitor glucose values after steroid
      administration for fetal lung maturity. The time course of glucose elevations is not clear,
      and how often the glucose elevations reach a level that would generally warrant treatment is
      unknown. When glucose monitoring is performed, no standard exists to guide the duration or
      frequency of monitoring.

      Detecting maternal hyperglycemia is important for several reasons, including:

        1. High maternal glucose levels lead to high fetal levels and prompt a fetal response to
           the high glucose levels. Some of the pregnancies may go on to deliver while the maternal
           glucose levels are still high, resulting in a higher risk of neonatal hypoglycemia in
           the nursery and an increased risk of acidosis and injury in the brain if periods of
           distress occur during labor. By the nature of the clinical situations, most fetuses born
           in the first few days following administration of steroids will also be preterm and
           possibly already have additional factors which put them at risk for complications in
           labor and the nursery, so the hyperglycemia compounds the risk for them.

        2. The maternal hyperglycemia may complicate the maternal course at a time when the
           pregnant woman is receiving other medications to control her premature labor or
           obstetric condition that prompted the use of the steroids in the first place. Fluid
           balance and constitutional symptoms may be affected by high glucose values. Rarely,
           diabetic ketoacidosis may be precipitated in someone with no history of diabetes.
    

Intervention name(s): antenatal corticosteroid
Intervention type(s): Other
Intervention description(s): Will look at maternal glucose level after corticosteroids
Observational model: Other
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Pregnant patients, who meet Inclusion/exclusion criteria