Glycemic control following two regimens of antenatal corticosteroids in mild gestational diabetes: A randomized controlled trial

Sukarna, Nuraini and Tan, Peng Chiong and Hong, Jesrine Gek Shan and Sulaiman, Sofiah and Omar, Siti Zawiah (2021) Glycemic control following two regimens of antenatal corticosteroids in mild gestational diabetes: A randomized controlled trial. Archives of Gynecology and Obstetrics, 304 (2). pp. 345-353. ISSN 0932-0067, DOI

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Purpose To compare 3 consecutive days of hyperglycemic response following antenatal dexamethasone regimens of 12-mg or 6-mg doses 12 hourly in diet-controlled gestational diabetes. Methods A randomized controlled trial was carried out in a university hospital in Malaysia. Women with lifestyle-controlled gestational diabetes scheduled to receive clinically indicated antenatal corticosteroids (dexamethasone) were randomized to 12-mg 12 hourly for one day (2 x 12-mg) or 6-mg 12-hourly for two days (4 x 6-mg). 6-point (pre and 2-h postprandial) daily self-monitoring of capillary blood sugar profile for up to 3 consecutive days was started after the first dexamethasone injection. Hyperglycemia is defined as blood glucose pre-meal >= 5.3 or 2 h postprandial >= 6.7 mmol/L. The primary outcome was a number of hyperglycemic episodes in Day-1 (first 6 BSP points). A sample size of 30 per group (N = 60) was planned. Results Median interquartile range] hyperglycemic episodes 4 2.5-5] vs. 4 3-5] p = 0.3 in the first day, 3 2-4] vs. 1 0-3] p = 0.01 on the second day, 0 0-1] vs. 0 0-1] p = 0.6 on the third day and over the entire 3 trial days 7 6-9] vs. 6 4-8] p = 0.17 for 6-mg vs. 12-mg arms, respectively. 2/30 (7%) in each arm received an anti-glycemic agent during the 3-day trial period (capillary glucose exceeded 11 mmol/L). Mean birth weight (2.89 vs. 2.49 kg p < 0.01) and gestational age at delivery (37.7 vs. 36.6 weeks p = 0.03) were higher and median delivery blood loss (300 vs. 400 ml p = 0.02) was lower in the 12-mg arm; all other secondary outcomes were not significantly different. Conclusion In gestational diabetes, 2 x 12-mg could be preferred over 4 x 6-mg dexamethasone as hyperglycemic episodes were fewer on Day-2, fewer injections were needed and the regimen was completed sooner.

Item Type: Article
Funders: Department of Obstetrics and Gynecology, University Malaya
Uncontrolled Keywords: Antenatal corticosteroids; Dexamethasone; Gestational diabetes mellitus; Blood sugar profile; Self-monitoring of blood glucose
Subjects: R Medicine > RG Gynecology and obstetrics
Divisions: Faculty of Medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 20 Jun 2022 01:08
Last Modified: 20 Jun 2022 01:08

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