Antenatal glucocorticoids and neonatal outcomes in type 1 diabetes pregnancy

Abstract

Rationale: Antenatal glucocorticoids are associated with improved outcomes in preterm infants, but their role is unclear in term offspring of high-risk pregnancies. For example, antenatal glucocorticoid administration in mothers with type 1 diabetes (T1D) in pregnancy has been reported to increase neonatal hypoglycemia risk, a common complication in this population. Both neonatal hypoglycemia and its cause, neonatal hyperinsulinism, may have chronic consequences on offspring neurological and cardiometabolic function. Objective: We aimed to assess the impact of antenatal glucocorticoid administration upon neonatal hypoglycemia risk and hyperinsulinism (assessed using cord blood C-peptide) in T1D pregnancy. Methods: We used data from the CONCEPTT randomized controlled trial of continuous glucose monitoring in pregnant women with T1D. Antenatal glucocorticoid administration was not randomised but given according to local protocols for perceived clinical need. C-peptide was measured in cord blood using an immunoassay. Results: Infants exposed to antenatal glucocorticoids had increased rates of neonatal complications, as expected, which were mostly explained by differences in gestational age at delivery. However, associations with elevated cord blood C-peptide, a marker of offspring hyperinsulinism, remained significant despite adjustment for gestational age and maternal hyperglycemia. Conclusions: Further assessment of risks and benefit of antenatal glucocorticoid administration in T1D pregnancy is warranted.