Time-dependent changes in insulin requirement for maternal glycemic control during antenatal corticosteroid therapy in women with gestational diabetes: a retrospective study
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- Itoh Arata
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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- Saisho Yoshifumi
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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- Miyakoshi Kei
- Department of Gynecology and Obstetrics, Keio University School of Medicine, Tokyo, Japan
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- Fukutake Marie
- Department of Gynecology and Obstetrics, Keio University School of Medicine, Tokyo, Japan
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- Kasuga Yoshifumi
- Department of Gynecology and Obstetrics, Keio University School of Medicine, Tokyo, Japan
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- Ochiai Daigo
- Department of Gynecology and Obstetrics, Keio University School of Medicine, Tokyo, Japan
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- Matsumoto Tadashi
- Department of Gynecology and Obstetrics, Keio University School of Medicine, Tokyo, Japan
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- Tanaka Mamoru
- Department of Gynecology and Obstetrics, Keio University School of Medicine, Tokyo, Japan
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- Itoh Hiroshi
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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抄録
Though recommended for pregnant women at risk of preterm birth to improve perinatal outcomes, antenatal corticosteroid (ACS) treatment can cause maternal hyperglycemia, especially in cases of glucose intolerance. A standardized protocol for preventing hyperglycemia during ACS treatment remains to be established. We herein retrospectively investigated the time-dependent changes in insulin dose required for maternal glycemic control during ACS treatment in gestational diabetes (GDM). Twelve singleton pregnant women with GDM who received 12 mg of betamethasone intramuscularly twice 24 hours apart were included in this analysis. Of those, eight also received ritodrine hydrochloride for preterm labor. The blood glucose levels were maintained at 70-120 mg/dL with continuous intravenous infusion of insulin and nothing by mouth for 48 hours after the first betamethasone administration. After the first dose of betamethasone, the insulin dosage needed for glycemic control gradually increased and reached a maximum (6.6 ± 5.8 units/hr) at 10 hours, then, decreased to 4.1 ± 1.5 units/hr at 24 hours. Similar changes in the insulin requirement were found after the second betamethasone dose (the maximum insulin dosage: 5.5 ± 1.6 units/hr at 9 hours following the second administration). Women treated with ritodrine hydrochloride needed more insulin, than those without ritodrine hydrochloride treatment (130.8 ± 15.0 vs. 76.8 ± 15.2 units/day, respectively, p < 0.05). Our data indicated that the requirement for insulin is highest 9-10 hours after each dose of betamethasone. When GDM is treated with ACS, levels of blood glucose should be carefully monitored, especially in patients treated with ritodrine hydrochloride.
収録刊行物
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- Endocrine Journal
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Endocrine Journal 63 (1), 101-104, 2016
一般社団法人 日本内分泌学会