Antenatal glucocorticoids and neonatal outcomes in type 1 diabetes pregnancy
International Journal of Gynecology and Obstetrics
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Meek, C. Antenatal glucocorticoids and neonatal outcomes in type 1 diabetes pregnancy. International Journal of Gynecology and Obstetrics https://doi.org/10.17863/CAM.79120
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.
The CONCEPTT trial is funded by Juvenile Diabetes Research Foundation (JDRF) grants #17‐2011‐533, and grants under the JDRF Canadian Clinical Trial Network, a public‐private partnership including JDRF and FedDev Ontario and supported by JDRF #80‐2010‐585. Medtronic supplied the CGM sensors and CGM systems at reduced cost. HRM conducts independent research supported by the National Institute for Health Research (Career Development Fellowship, CDF-2013-06-035), and is supported by Tommy’s charity. CLM is supported by the Diabetes UK Harry Keen Intermediate Clinical Fellowship (DUK-HKF 17/0005712) and the EFSDNovo Nordisk Foundation Future Leader’s Award (NNF19SA058974). SF is funded through a BBSRC grant (BB/M027252/1).
Diabetes UK (17/0005712)
Novo Nordisk Foundation (NNF19SA058974)
European Foundation for the Study of Diabetes (EFSD) (NNF19SA058974)
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This record's DOI: https://doi.org/10.17863/CAM.79120
This record's URL: https://www.repository.cam.ac.uk/handle/1810/331667
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