Adoption of a pregnancy‐specific intravenous insulin protocol (<scp>Pregnancy‐IVI</scp>) at a regional centre has equivalent safety and efficacy outcomes as a tertiary hospital

Rowe, Christopher W; Qiao, Vivian; Ramesh, S; Rosee, Patrick; Sathiakumar, Angeline; McWhae-Brown, Sienna; Griffiths, Eliza; Wynne, Katie

doi:10.1111/dme.15003

Cited by 1 publication

(2 citation statements)

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“…This prospective cohort study at a tertiary obstetric and endocrine hospital in Australia enrolled all women with DIP receiving ACS and treated with the Pregnancy‐IVI between 2017 and 2021. At this centre, it is standard of care for all women with DIP receiving ACS to be admitted to an obstetric ward for monitoring (staffing ratio: 1 midwife for 4 women) and treated with intravenous insulin if required, according to the previously published and validated Pregnancy‐IVI protocol 13,14,21 . Briefly, intravenous insulin is commenced if any single maternal blood glucose level (BGL) is greater than 6.7 mmol/L in the 24 h following betamethasone, with the rate of IVI adjusted according to a treat‐to‐target written protocol based on capillary glucose measures taken every 30–60 min and continued for 24 h after the final dose of betamethasone.…”

Section: Methodsmentioning

confidence: 99%

“…to an obstetric ward for monitoring (staffing ratio: 1 midwife for 4 women) and treated with intravenous insulin if required, according to the previously published and validated Pregnancy-IVI protocol. 13,14,21 Briefly, intravenous insulin is commenced if any single maternal blood glucose level (BGL) is greater than 6.7 mmol/L in the 24 h following betamethasone, with the rate of IVI adjusted according to a treat-to-target written protocol based on capillary glucose measures taken every 30-60 min and continued for 24 h after the final dose of betamethasone. Usual subcutaneous insulin and metformin were continued if prescribed prior.…”

Section: Overviewmentioning

confidence: 99%

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Factors associated with maternal hyperglycaemia and neonatal hypoglycaemia after antenatal betamethasone administration in women with diabetes in pregnancy

Rowe,

Rosee,

Sathiakumar

et al. 2023

Diabet Med

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AimsBespoke glycaemic control strategies following antenatal corticosteroids for women with diabetes in pregnancy (DIP) may mitigate hyperglycaemia. This study aims to identify predictive factors for the glycaemic response to betamethasone in a large cohort of women with DIP.MethodsEvaluation of a prospective cohort study of 347 consecutive DIP pregnancies receiving two doses of 11.4 mg betamethasone 24 h apart between 2017 and 2021 and treated with the Pregnancy‐IVI intravenous insulin protocol. Regression modelling identified factors associated with maternal glycaemic time‐in‐range (TIR) and maternal insulin requirements following betamethasone. Factors associated with neonatal hypoglycaemia (glucose <2.6 mmol/L) in infants born within 48 h of betamethasone administration (n = 144) were investigated.ResultsThe mean maternal age was 31.9 ± 5.8 years, with gestational age at betamethasone of 33.5 ± 3.4 weeks. Gestational diabetes was present in 81% (12% type 1; 7% type 2). Pre‐admission subcutaneous insulin was prescribed for 63%. On‐infusion maternal glucose TIR (4.0–7.8 mmol/L) was 83% [IQR 77%–90%] and mean on‐IVI glucose was 6.6 ± 0.5 mmol/L. Maternal hypoglycaemia (<3.8 mmol/L) was uncommon (0.47 h/100 on‐IVI woman hours). Maternal glucose TIR was negatively associated with indicators of insulin resistance (type 2 diabetes, polycystic ovary syndrome), late‐pregnancy complications (pre‐eclampsia, chorioamnionitis) and the 1‐h OGTT result. Intravenous insulin requirements were associated with type of diabetes, pre‐eclampsia and intrauterine infection, the 1‐h OGTT result and the timing of betamethasone administration. Neonatal hypoglycaemia was associated with pre‐existing diabetes but not with measures of glycaemic control.ConclusionAn intravenous infusion protocol effectively controls maternal glucose after betamethasone. A risk‐factor‐based approach may allow individualisation of therapy.

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Section: Methodsmentioning

confidence: 99%

Section: Overviewmentioning

confidence: 99%