Effect of low dose prednisone on glucose metabolism levels in patients with spontaneous abortion: a single-center, prospective cohort study

Abstract

Objective: To explore the effect of low dose prednisone treatment during pregnancy on blood glucose levels in patients with spontaneous abortion. Methods: In this single-center, prospective cohort study, patients with a history of spontaneous abortion were enrolled and were assigned to two groups according to whether they were exposed to low dose prednisone during pregnancy. All patients received oral glucose tolerance test (OGTT) at early pregnancy (before 12th week) and late pregnancy (24-28th week). Fasting serum C-peptide and plasma glycosylated hemoglobin (HbA1c) levels were measured at the same time. We compared the results of OGTT, fasting serum C-peptide levels and HbA1c levels between the two groups and analyzed the incidence of diabetes mellitus (DM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in early pregnancy and the incidence of gestational diabetes mellitus (GDM) in late pregnancy. Result: A total of 355 patients were enrolled and analyzed. No significant difference in OGTT between the two groups were observed in the first trimester (P=0.142). However, patients in the prednisone group showed a significant increase in fasting serum C-peptide (P<0.001). Regarding late pregnancy, although there was no significant difference in OGTT between the two groups (P=0.070), patients in the prednisone group showed a significant increase in 2-h plasma glucose (P=0.010). Patients in the prednisone group also had a higher incidence of GDM compared with the control group (P=0.005). Furthermore, family history of DM and receiving low dose prednisone were significantly associated with higher risk of gestational glycometabolism abnormality and receiving HCQ reduced the risk of that in patients with spontaneous abortion. Conclusion: Long-term exposure of low dose prednisone during pregnancy could impair postprandial blood glucose and increase the incidence of GDM. Routine monitor of blood glucose and C-peptide levels should be recommended in patients who received prednisone treatment during pregnancy. Family history of DM and exposure to low dose prednisone are both independent risk factors for gestational glycometabolism abnormality while receiving HCQ is a protective one in patients with spontaneous abortion. Trial registration Chinese Clinical Trials Registration: ChiCTR2100046455 (16/05/2021).