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- Title
Glycemic control following two regimens of antenatal corticosteroids in mild gestational diabetes: a randomized controlled trial.
- Authors
Sukarna, Nuraini; Tan, Peng Chiong; Hong, Jesrine Gek Shan; Sulaiman, Sofiah; Omar, Siti Zawiah
- Abstract
<bold>Purpose: </bold>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.<bold>Methods: </bold>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 × 12-mg) or 6-mg 12-hourly for two days (4 × 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.<bold>Results: </bold>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.<bold>Conclusion: </bold>In gestational diabetes, 2 × 12-mg could be preferred over 4 × 6-mg dexamethasone as hyperglycemic episodes were fewer on Day-2, fewer injections were needed and the regimen was completed sooner.<bold>Clinical Trial Registration: </bold>http://www.isrctn.com/ISRCTN16613220 .
- Subjects
MALAYSIA; GESTATIONAL diabetes; GLYCEMIC control; RANDOMIZED controlled trials; CORTICOSTEROIDS; BLOOD sugar
- Publication
Archives of Gynecology & Obstetrics, 2021, Vol 304, Issue 2, p345
- ISSN
0932-0067
- Publication type
journal article
- DOI
10.1007/s00404-020-05950-3