Real-life experience with antenatal glucocorticoid administration in premature pregnancies complicated by diabetes mellitus

Abstract

Real-life experience with antenatal glucocorticoid administration in premature pregnancies complicated by diabetes mellitus Anca-Gabriela Dumitrescu1 , Teodor Salmen2,*, Florentina Furtunescu3 , Costin Berceanu4 , Corina Grigoriu5,6,*, Roxana-Elena Bohîlțea5,7,*, Simona Daniela Popescu8 1Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania 2Department of Diabetes, Nutrition and Metabolic Diseases, “Prof. Dr. N.C.Paulescu” National Institute of Diabetes, Nutrition and Metabolic Disorders, 020475 Bucharest, Romania 3Department of Public Health and Management, Faculty of Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania 4Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania 5Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania 6Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania 7Department of Obstetrics and Gynecology, “Filantropia” Clinical Hospital, 011171 Bucharest, Romania 8Department of Neonatology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania *Correspondence: teodor.salmen@gmail.com (Teodor Salmen); corigri@gmail.com (Corina Grigoriu); r.bohiltea@yahoo.com (Roxana-Elena Bohîlțea) Academic Editor: Michael H. Dahan Submitted: 9 December 2021 Revised: 21 January 2022 Accepted: 22 January 2022 Published: 2 April 2022 Abstract Background: Diabetes mellitus (DM) in pregnancy is associated with an increased risk of premature birth, which therefore increases the risk of acute respiratory distress syndrome (ARDS) of the neonate and is associated with high morbidity and mortality of the newborn. The administration of glucocorticoids to the mother before premature birth decreases the risk of neonatal complications. However, the data regarding the administration of this therapy to mothers with DM is limited. Clinical guidelines recommend treating them in the same manner as the non-DM women, even if there is no recent data to support the benefit in this subpopulation. The aim of this study is to evaluate the real-life effects of glucocorticoid administration on the maternal and fetal prognosis of pregnancies complicated with DM. Material and methods: A retrospective study was conducted on 67 pregnant females who were admitted to the Obstetrics & Gynecology Department of The Emergency University Hospital of Bucharest between December 2016–March 2021, and who received corticosteroid before prematurely giving birth to 70 newborns. There was a group of 33 mothers with DM and a second group with 34 non-DM pregnant women selected for control of glucocorticoids’ real-life administration in the high risk for premature birth population. Results: The administration of glucocorticoids was not restricted by the presence of DM; 78% of the mothers with DM and 79.41% of the mothers without DM received one course of antenatal glucocorticoids for fetal lung maturation (p = 0.6). The incidence of ARDS differs between groups was statistically insignificant: 35.29% in the DM group versus 30.55% in the control group (p = 0.8). There were similar cases of maternal complications such as pregnancy-induced hypertension (PIH), or preeclampsia in the two groups. These findings suggest that glucocorticoid therapy is effective for premature newborns from pregnancies with DM and does not negatively impact the complication rate of the mothers, sustaining their administration in these cases. Conclusions: The administration of antenatal glucocorticoids before premature birth is not influenced by the presence of DM regarding Apgar score at 1 and 5 minutes, the incidence of ARDS, but there were differences such as more large for gestational age (LGA) newborns and neonatal hypoglycemia in the DM group. Considering the low number of patients enrolled from a single-center, future multicentric studies are needed. It is important to emphasize that this study’s findings reflect the local practice and cannot be generalized. Keywords: glucocorticoids; corticosteroids; diabetes mellitus; neonatal outcome; premature birth; acute respiratory distress syndrome