Endocrine Abstracts

Introduction: Betamethasone (BM) is widely used in pregnancy. Its diabetogenic potential is known, and in combination with placental insulin resistance in pregnancy, leads to a transient increase in glycemia. Our aim was to study the changes in glycemia in women with singleton pregnancies and pre-existing diabetes mellitus, under insulin therapy, after administration of BM for obstetric causes.

Materials and methods: We closely monitored and assessed the glycemic profile of 11 women with singleton pregnancies (mean age ± s.d.: 35.5 ± 5.0 years; mean gestational age ± s.d.: 33.6 ± 3.7 weeks; mean weight gain± s.d. : 9.8 ± 5.6 kg) who were given BM during their hospitalization for obstetric causes. Three women had DM type 1, five women DM type 2, one woman MODY-1, and one woman had cystic fibrosis-related diabetes. Nine women received 24 mg of BM and 2 women 12 mgof BM, respectively. Five women had concurrent thyroid disease. The evaluation of glycemia was based on ten capillary plasma blood glucose measurements/day with point-of-caredevices. The intervention for correction of hyperglycemia was in accordance with ADA and EASD guidelines. We used analysis of covariance to assess the total daily insulin dose after BM, with age, gestational age, weight change in pregnancy, BM dosage, insulin dosage before BM, duration of hyperglycemia as variables and the presence of thyroid disease as a factor.

Results: Asignificant change in the glycemic profile in most patients was noted during the first 24 hours of BM administration, lasting on average approximately 2.1 ± 1.0 days. The mean increase in total daily dose of insulin was of 14.4% (in two women their insulin needs decreased whereas in nine women their insulin needs increased by 25.7%). The noted increase in insulin needs tended to be associated with insulin dosage before BM (P = 0.062) and the duration of hyperglycemia (P = 0.077); it was unrelated to diabetes type (P = 0.151).

Conclusions: The alteration in glycemia, after BM administration was as expected. However, the increase in insulin needs was lower than the reported in the literature increase of 30–40%. This could be attributed to greater attention and compliance of women with previous known diabetes entering pregnancy, compared to women with newly diagnosed diabetes during gestation. Further studies are needed to draw more reliable conclusions.