International Journal of Obstetrics and Gynecology ISSN: 2736-1594 Vol. 10 (4), pp. 001-004, April, 2022. © International Scholars Journals
Brief Communication: Antenatal glucocorticoids and neonatal outcomes in type 1 diabetes pregnancy
Claire L. Meek [ORC ID 0000-0002-4176-8329] 1,2,3*, Zoe Stewart4, Samuel Furse1, Jennifer Yamamoto5, Catherine E. Aiken1,6, Denice S. Feig7, Albert Koulman1, Helen R. Murphy2,8,9
1The Wellcome Trust-MRC Institute of Metabolic Science, Metabolic Research Laboratories, University of Cambridge, Addenbrookes’s Hospital, Box 289, Hills Road, Cambridge, CB2 0QQ, United Kingdom. 2Wolfson Diabetes and Endocrinology Clinic, Cambridge University Hospitals, Addenbrookes’s Hospital, Box 289, Hills Road, Cambridge, CB2 0QQ, United Kingdom. 3Department of Clinical Biochemistry, Cambridge University Hospitals, Addenbrookes’s Hospital, Box 281, Hills Road, Cambridge, CB2 0QQ, United Kingdom. 4Academic Clinical Lecturer in Obstetrics and Gynaecology, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK. 5Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. 6Department of Obstetrics, Cambridge University Hospitals, Addenbrookes’s Hospital, Box 281, Hills Road, Cambridge, CB2 0QQ, United Kingdom. 7Mount Sinai Hospital, Department of Medicine, University of Toronto; Lunenfeld-Tanenbaum Research Institute, Toronto, Canada. 8Norwich Medical School, University of East Anglia, Norwich, UK. 9Department of Women and Children’s Health, King’s College London, London, UK.
Accepted 17 December, 2021
Rationale: Antenatal glucocorticoids are associated with improved outcomes in preterm infants, but their role is unclear in term offspring of high-risk pregnancies. For example, antenatal glucocorticoid administration in mothers with type 1 diabetes (T1D) in pregnancy has been reported to increase neonatal hypoglycemia risk, a common complication in this population. Both neonatal hypoglycemia and its cause, neonatal hyperinsulinism, may have chronic consequences on offspring neurological and cardiometabolic function. Objective: We aimed to assess the impact of antenatal glucocorticoid administration upon neonatal hypoglycemia risk and hyperinsulinism (assessed using cord blood C-peptide) in T1D pregnancy. Methods: We used data from the CONCEPTT randomized controlled trial of continuous glucose monitoring in pregnant women with T1D. Antenatal glucocorticoid administration was not randomised but given according to local protocols for perceived clinical need. C-peptide was measured in cord blood using an immunoassay. Results: Infants exposed to antenatal glucocorticoids had increased rates of neonatal complications, as expected, which were mostly explained by differences in gestational age at delivery. However, associations with elevated cord blood C-peptide, a marker of offspring hyperinsulinism, remained significant despite adjustment for gestational age and maternal hyperglycemia. Conclusions: Further assessment of risks and benefit of antenatal glucocorticoid administration in T1D pregnancy is warranted.
Keywords: Type 1 diabetes; pregnancy; antenatal glucocorticoids; neonatal hypoglycemia; Cord C-peptide; hyperinsulinism; perinatal complications.