Effect of antenatal betamethasone on blood glucose levels in women with and without diabetes

Jolley, Jennifer; Rajan, Priya; Petersen, Rita; Fong, Alex; Wing, Deborah A.

doi:10.1016/j.diabres.2016.06.005

Cited by 51 publications

(43 citation statements)

References 19 publications

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“…The glucose curves overlapped for the five corticosteroid treatments indicating equivalent effects on blood sugar despite the differences in PK for DexP and BetaP. This glucose value is higher than for the report for women in labor, 24 probably because of the lower weight and BMI of the women in this study. Maternal hyperglycemia will cause hypoglycemia in newborns, which increased from 15% to 24% in a trial of ACS for late preterm pregnancies.…”

Section: Discussioncontrasting

confidence: 67%

“…23 Pregnant women with BMI < 30 had blood glucose levels > 140 mg/dL for 15 hours following the BetaP plus BetaA, with lower glucose values for women with BMI > 30. 24 In this population of low weight women with an average BMI of 24, the five single treatments increased blood sugar to about 200 mg/dL at 6 hours, with a return to the baseline value after about 30 hours. The glucose curves overlapped for the five corticosteroid treatments indicating equivalent effects on blood sugar despite the differences in PK for DexP and BetaP.…”

Section: Discussionmentioning

confidence: 86%

“…Pregnant women treated with BetaP plus BetaA and monitored with continuous glucose monitors had glucose elevations for 2 days . Pregnant women with BMI < 30 had blood glucose levels > 140 mg/dL for 15 hours following the BetaP plus BetaA, with lower glucose values for women with BMI > 30 . In this population of low weight women with an average BMI of 24, the five single treatments increased blood sugar to about 200 mg/dL at 6 hours, with a return to the baseline value after about 30 hours.…”

Section: Discussionmentioning

confidence: 87%

“…The peak plasma concentration (C max ) and time of maximum plasma concentration (T max ) values are comparable for the two drugs ( Table 2). The terminal half-life (t 1/2 ) value for BetaP is twice as long as for DexP, and the differences in the AUC 24 or AUC 96 values result from the lower apparent clearance (CL/F) for BetaP. BetaP plus BetaA has a multiphasic concentration-time profile due to the mixture of the fast release BetaP and slow release BetaA, with a C max of 35.4 ng/mL, about 50% of BetaP or DexP C max , and a T max of 3 hours, similar to BetaP.…”

Section: Pks Of Dex and Betamentioning

confidence: 99%

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Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India

Jobe

Milad²,

Peppard

et al. 2019

Clinical Translational Sci

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High‐dose betamethasone and dexamethasone are standard of care treatments for women at risk of preterm delivery to improve neonatal respiratory and mortality outcomes. The dose in current use has never been evaluated to minimize exposures while assuring efficacy. We report the pharmacokinetics and pharmacodynamics (PDs) of oral and intramuscular treatments with single 6 mg doses of dexamethasone phosphate, betamethasone phosphate, or a 1:1 mixture of betamethasone phosphate and betamethasone acetate in reproductive age South Asian women. Intramuscular or oral betamethasone has a terminal half‐life of 11 hours, about twice as long as the 5.5 hours for oral and intramuscular dexamethasone. The 1:1 mixture of betamethasone phosphate and betamethasone acetate shows an immediate release of betamethasone followed by a slow release where plasma betamethasone can be measured out to 14 days after the single dose administration, likely from a depo formed at the injection site by the acetate. PD responses were: increased glucose, suppressed cortisol, increased neutrophils, and suppressed basophils, CD3CD4 and CD3CD8 lymphocytes. PD responses were comparable for betamethasone and dexamethasone, but with longer times to return to baseline for betamethasone. The 1:1 mixture of betamethasone phosphate and betamethasone acetate caused much longer adrenal suppression because of the slow release. These results will guide the development of better treatment strategies to minimize fetal and maternal drug exposures for women at risk of preterm delivery.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 87%

Section: Pks Of Dex and Betamentioning

confidence: 99%

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Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India

Jobe

Milad²,

Peppard

et al. 2019

Clinical Translational Sci

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“…Great attention is paid to the group of pregnant women who have either pre-existing diabetes or gestational diabetes, and especially those under insulin therapy. In this case, it is recommended, by limited bibliographic data, to up-titrate the insulin dose by 30%-40% in order to prevent very high blood glucose levels, which may exacerbate an already at-risk pregnancy (hydramnios) [7][8][9][10][11][12][13][14][15][16]. Furthermore, hyperglycemia can lead to severe neonatal hypoglycemia in the case of preterm delivery [7,9,12].…”

Section: Introductionmentioning

confidence: 99%

Glycemia after Betamethasone in Pregnant Women without Diabetes—Impact of Marginal Values in the 75-g OGTT

et al. 2020

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Betamethasone (BM) administration in pregnancy has been shown to reduce the incidence and severity of neonatal respiratory distress syndrome. Its known diabetogenic impact, combined with placental insulin resistance, leads to a transient increase in glycemia. However, its effect on glucose homeostasis in pregnancy has not been adequately investigated. We closely monitored and assessed the glycemic profile of 83 pregnant women, with normal glucose metabolism, who were given BM during their hospitalization due to threatened premature labor. A significant change in the glycemic profile in most patients was noted, lasting 1.34 ± 1.05 days. Sixty-six of eighty-three women were eventually treated with insulin to maintain glycemia within acceptable limits. The mean ± SD insulin dosage was 12.25 ± 11.28 units/day. The need for insulin therapy was associated with higher BM doses and the presence of marginal values in the 75-g oral glucose tolerance test (OGTT) at 60 min. Our study demonstrates, following BM administration, the need for increased awareness and individualized monitoring/treatment of pregnant women with normal-yet marginal-values in the 75-g OGTT.

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Controversies in antenatal corticosteroid treatment

Thevathasan

Said

2020

Prenatal Diagnosis

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Antenatal corticosteroids are now established as one of the cornerstones of therapy in the prevention of neonatal morbidity and mortality prior to preterm birth. Although this practice is widely accepted, a significant number of controversies exist. This review explores the knowledge gaps regarding the use of antenatal corticosteroids in the preterm, late preterm and term populations. Furthermore, the role of antenatal corticosteroids in special populations, such as diabetes, multiple pregnancies and periviable gestations, where high‐quality data from randomized controlled trials are lacking, is also considered.

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Effect of antenatal betamethasone on blood glucose levels in women with and without diabetes

Cited by 51 publications

References 19 publications

Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India

Pharmacokinetics and Pharmacodynamics of Intramuscular and Oral Betamethasone and Dexamethasone in Reproductive Age Women in India

Glycemia after Betamethasone in Pregnant Women without Diabetes—Impact of Marginal Values in the 75-g OGTT

Controversies in antenatal corticosteroid treatment

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