Hyperglycemia, Neonatal Hypoglycemia, Preterm Birth, Threatened Preterm Labor
Conditions
Keywords
Preterm birth, Betamethasone, Continuous glucose monitoring, Antenatal corticosteroids
Brief summary
In case of threatening preterm birth, it is standard to recommend treatment with betamethasone to accelerate fetal lung maturation. In pregnant women with diabetes, treatment with betamethasone can lead to significant hyperglycemia, which may cause hypoglycemia in the neonate. Changes in blood glucose in non-diabetic women are less investigated. In this study we aim to examine changes in maternal blood glucose levels in non-diabetic women, during treatment with betamethasone, by continuous glucose monitoring. Hypotheses: Administration of betamethasone induce significant hyperglycemia in non-diabetic pregnant women during treatment.
Detailed description
Antenatal corticosteroid administration is an important treatment to reduce the incidence of neonatal respiratory distress syndrome, and improve neonatal outcomes of babies born premature. Administration of betamethasone however also affects the maternal glucose homeostasis, and it is well-known that in pregnant women with diabetes, the administration of glucocorticoids can lead to significant maternal hyperglycemia, and hypoglycemia in the neonate, unless the insulin dosage is adjusted accordingly. Administration of betamethasone also affects the glucose homeostasis in pregnant non-diabetic women. However, only few studies have investigated the changes in the blood glucose levels in non-diabetic pregnant women, and a more accurate depiction of the glycemic response to betamethasone can be obtained by continuous glucose monitoring. Recruitment of participants will occur upon their arrival with symptoms of threatened preterm birth, when it is decided to start treatment with betamethasone for fetal lung maturation. To measure blood glucose levels in the pregnant women, a continuous glucose monitor (CGM) will be used. Further, blood samples will be collected on days 1-6 after inclusion, for measurement of: Insulin, blood glucose, 3-hydroxybutyrat, HgbA1c, CRP and leucocytes. Urine dipstick test for ketones and glucose will be performed twice daily. After delivery, a blood sample will be extracted from the umbilical cord for measurement of Ph, base-excess, glucose, insulin c-peptide and inflammatory markers. Information on hypoglycemia and/or the need for early feeding of the infant after birth will be recorded. Perspectives: The results of this study will help us understand how the administration of betamethasone affects maternal blood glucose levels. If it is found, that administration of betamethasone causes significant hyperglycemia in the pregnant women, it may be important to measure and treat hyperglycemia during betamethasone treatment, to ensure the effect of betamethasone and prevent neonatal complications due to hypoglycemia.
Interventions
None listed
Sponsors
University of Aarhus
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Pregnant in gestational week 24+0 - 34+0 admitted with symptoms of threatened preterm birth: * Premature contractions and shortening of the cervix, or * Preterm premature rupture of membranes. * Treatment with betamethasone for fetal lung maturation is planned, or started (maximum 4 hours before inclusion) * Age over 18 years * Read and understand Danish
Exclusion criteria
* Multiple pregnancy * Diabetes * Pre-existing maternal use of medications that affect glucose metabolism
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maternal blood glucose levels before, under and after the administration of betamethasone | 7-14 days | Blood glucose levels (mmol/L) will be measured continuously using a continuous glucose monitor including a small electrode under the skin |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The level of 3-hydroxybuturat (mmol/L) in maternal blood before, during and after treatment with Betamethasone | 7 days. From the day betamethasone is given untill 6 days after the first dose | Blood samples will be collected on days 1-6, where day 1 is the day where the first dose of betamethasone is given. |
| Level of leukocytes (White blood cell count) (mia/L) in maternal blood before, during and after treatment with betamethasone | 7 days, from day one (the day where the first dose of betamethasone is given) untill 6 days after the first dose. | Blood samples will be collected on days 1-6, where day 1 is the day where the first dose of betamethasone is given. |
| The level of CRP (C-reactive protein)(nmol/ml) in maternal blood before, during and after treatment with betamethasone | 7 days. From the day betamethasone is given untill 6 days after the first dose. | Blood samples will be collected on days 1-6, where day 1 is the day where the first dose of betamethasone is given. |
| The level of glucose (mmol/L) in umbilical cord blood at delivery | At delivery of the baby | After the birth and cord occlusion a blood sample will be drawn from the umbilical cord |
| The level of insulin (pmol/L)in maternal blood before, during, and after the effect of betamethasone | 7 days. From the day betamethasone is given untill 6 days after the first dose | Blood samples will be collected on days 1-6, where day 1 is the day where the first dose of betamethasone is given. |
| The level of c-peptid (pmol/L) in umbilical cord blood at delivery | At delivery | After the birth and cord occlusion a blood sample will be drawn from the umbilical cord |
| The level af adiponectin (ug/ml) in umbilical cord blood at delivery | At delivery | After the birth and cord occlusion a blood sample will be drawn from the umbilical cord |
| The level of leptin (ng/ml) in umbilical cord blood at delivery | At delivery | After the birth and cord occlusion a blood sample will be drawn from the umbilical cord |
| Number of infants with need for early feeding (yes/no) after birth | First two days after birth | Information from files on whether the infant was given Early feeding after delivery (yes/no) |
| The level of insulin (pmol/L) in umbilical cord blood at delivery | At delivery | After the birth and cord occlusion a blood sample will be drawn from the umbilical cord |
Countries
Denmark
Contacts
Primary ContactVictoria Bøttker
Backup ContactPuk Sandager, MD, PhD
Outcome results
None listed