Ritodrine Should Be Carefully Administered during Antenatal Glucocorticoid Therapy Even in Nondiabetic Pregnancies

Abstract

Aim. Antenatal glucocorticoid therapy (AGT) has been commonly used recently. However, this therapy has severe harmful effects such as maternal hyperglycemia. In Japan, ritodrine hydrochloride has been used as a tocolytic agent. In this study, we performed retrospective casecontrol study to clarify whether concomitant use of ritodrine and glucocorticoid was safe to pregnant women without diabetes mellitus. Methods. We reviewed the computerized records of pregnant women with pregestational diabetes (n = 9) and nondiabetes (n = 45) who gave birth at our hospital between 2002 and 2011. Cases and controls received AGT. Blood glucose after the therapy was analyzed, and additional volume of insulin was compared to that before the therapy. Results. From this study, 30 units of insulin were necessary when performing AGT in diabetic pregnant women. And also, an increase in blood glucose of 40 mg/dL was seen after the therapy even in nondiabetic pregnant women. Blood glucose increased significantly in the group that also received ritodrine, and it was shown that the number of pregnant women who might develop ketoacidosis might increase 11-fold. Conclusions. Ritodrine should be carefully administered during antenatal glucocorticoid therapy. It may be necessary to adequately monitor blood glucose, when performing the therapy, even in nondiabetic pregnant women.

Time-dependent changes in insulin requirement for maternal glycemic control during antenatal corticosteroid therapy in women with gestational diabetes: a retrospective study

“…Ogawa et al [9] also have shown that women receiving ritodrine hydrochloride needed larger amount of insulin by approximately 30 units per day than those without ritodrine hydrochloride during ACS treatment. Ritodrine hydrochloride, β2-sympathomimetics, is a common tocolytic drug in obstetric practice in Japan, although its efficacy is limited.…”

“…The optimal maternal glycemic control is necessary during ACS treatment in pregnancies with GDM as well as DM because maternal hyperglycemia is associated with fetal acidosis [3,4]. Several authors have demonstrated maternal glycemic control after the corticosteTime-dependent changes in insulin requirement for maternal glycemic control during antenatal corticosteroid therapy in women with gestational diabetes: a retrospective study [5][6][7][8][9]. However, data on the timedependent changes in insulin requirement during the treatment is limited especially in Japanese women with GDM.…”

Risk Factors for the Requirement of Antenatal Insulin Treatment in Gestational Diabetes Mellitus

“…Even in nondiabetic pregnancy in women with normal glucose tolerance, it raised blood glucose levels additional 2.2 mmol/L (40 mg/dl) [17] and the continuous ritodrine infusion increased plasma glucose levels during first 24 hours after beginning of ritodrine [18]. In contrast, the Canadian preterm labor investigators group reported that the incidences of hyperglycemia were similar between ritodrine and placebo infusion group [19].…”

Antenatal steroids

“…The higher single steroid dose most commonly caused maternal anaemia and a significant increase in leukocytosis. The administration of a total dose of 24 mg is most likely the most important for maximal neonatal benefits, but a lower single steroid dose may be useful to reduce maternal side effects, including those in patients with prepregnancy diabetes [28,29] .…”