Dr Qureshi Sehrish1, Dr Gauthami Bhagwanani1, Dr Waseem Buksh1
1Liverpool Hospital, Liverpool, Australia
Biography:
Biographies to come
Abstract:
Gestational diabetes mellitus (GDM) occurs in about 17.9% women in Australia. Increasing rates of obesity and increasing maternal age means that the prevalence of GDM is likely to increase in the future. Rates of preterm delivery have also been increasing in Australia in recent years. When pre-term delivery is anticipated it is current practice to administer corticosteroids for fetal lung maturity prior to delivery. Corticosteroids administered in this instance when women also have GDM leads to an increase in blood glucose levels (BGLs). This temporary increase in BGLs can lead to an adverse effect on neonatal glycaemic control if the baby is born during this period.
In the tertiary hospital where the authors practice, the Obstetric team consult the Endocrinology team for advice regarding optimisation of BGLs when administering steroids. In order to streamline this process, we developed a protocol to reduce the burden of phone calls required and assist with BGL control post corticosteroid administration.
This analysis is looking at the results of implementation of this protocol. The protocol assumes that a 40-50% increase in insulin is required post corticosteroid administration.
This was a single centred prospective study conducted in a major tertiary hospital with a multi-disciplinary team input.
From the study, we have concluded that day 1 and 2 fasting and post meals BGL’s were significantly elevated requiring additional insulin. We classified the two groups in Group A, patients who were not part of the protocol and Group B, patients whose insulin was adjusted according to the protocol. There was a significant reduction in supplemental insulin requirement in Group B. Hence Implementation of this protocol has streamlined the process of glycaemic optimisation in women with GDM who receive corticosteroids in our hospital.
Keywords
Gestation diabetes, Corticosteroids
References
Annie R.A McDougall Effect of antenatal corticosteroid administration-to-birth interval on maternal and newborn outcomes: a systemic review 2023: a sy stematic review
Josephine G Laurie: A Review of the Current Status of Gestational Diabetes Mellitus in Australia—The Clinical Impact of Changing Population Demographics and Diagnostic Criteria on Prevalence 2022