Gestational diabetes mellitus in patients receiving long-term corticosteroid therapy during pregnancy
-
Yusuf Yildirim
Abstract
Aim: Little data exist on the impact of chronic low dose corticosteroid therapy during pregnancy on gestational diabetes mellitus (GDM).
Method: We compared 25 pregnant women receiving long-term (>4 weeks) corticosteroid for newly diagnosed idiopathic thrombocytopenic purpura (ITP) (study group) and 108 normal pregnant women (control group) in this case-control study. Main outcome measures were 1-h, 50-g and 3-h, 100-g glucose tolerance tests (GTTs). Women in both groups were also screened with 75-g GTT 6 weeks after delivery.
Results: The mean duration of corticosteroid therapy was 9.8±4.9 (range 6–25) weeks. Compared with controls, study group patients had a greater prevalence of diagnosed GDM (24.0 vs. 2.8%, P=0.01). Of these patients, 83.3% were diagnosed with GDM at 16 weeks gestation. An impaired 75-g GTT was also more frequent in the study group (P=0.01).
Conclusion: Our findings suggest that long-term corticosteroid therapy may be associated with the development of diabetes in pregnant women and early GTT should be performed in pregnant women on corticosteroid therapy.
References
1 ACOG practice bulletin: Thrombocytopenia in pregnancy. Number 6, September 1999. Clinical management guidelines for obstetrician-gynecologists. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 67 (1999) 117Search in Google Scholar
2 Alberico S, C Strazzanti, D De Santo, F De Seta, P Lenardon, M Bernardon, et al.: Gestational diabetes: universal or selective screening? J Matern Fetal Neonatal Med16 (2004) 331Search in Google Scholar
3 Damm P, C Kuhl, A Bertelsen, L Molsted-Pedersen: Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus. Am J Obstet Gynecol167 (1992) 607Search in Google Scholar
4 Dornhorst A, M Rossi: Risk and prevention of type 2 diabetes in women with gestational diabetes. Diabetes Care21 (1998) 43Search in Google Scholar
5 Ferrara A, HS Kahn, CP Quesenberry, C Riley, MM Hedderson: An increase in the incidence of gestational diabetes mellitus: Northern California, 1991–2000. Obstet Gynecol103 (2004) 526Search in Google Scholar
6 Fisher JE, RS Smith, R Lagrandeur, RP Lorenz: Gestational diabetes mellitus in women receiving beta-adrenergics and corticosteroids for threatened preterm delivery. Obstet Gynecol90 (1997) 880Search in Google Scholar
7 Geva E, A Amit, L Lerner-Geva, Y Yaron, Y Daniel, T Schwartz, et al.: Prednisone and aspirin improve pregnancy rate in patients with reproductive failure and autoimmune antibodies: a prospective study. Am J Reprod Immunol43 (2000) 36Search in Google Scholar
8 Gowda VV, J Apuzzio, A Langer, TS Li, M Devanesan, J Harrigan: Pregnancy complicated by refractory idiopathic thombocytopenic purpura and diabetes mellitus. J Reprod Med19 (1977) 147Search in Google Scholar
9 Kim C, KM Newton, RH Knopp: Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care25 (2002) 1862Search in Google Scholar
10 Kondo H, T Imamura: Pernicious anemia (PA) subsequent to insulin-dependent diabetes mellitus and idiopathic thrombocytopenic purpura, and effects of oral cobalamin on PA. Am J Hematol62 (1999) 61Search in Google Scholar
11 Kuhl C: Etiology and pathogenesis of gestational diabetes. Diabetes Care21 (1998) 1910.2337/diacare.21.1.S60Search in Google Scholar
12 Landy HJ, NB Isada, J McGinnis, R Ratner, JH Grossman 3rd: The effect of chronic steroid therapy on glucose tolerance in pregnancy. Am J Obstet Gynecol159 (1988) 612Search in Google Scholar
13 Laros RK, RL Sweet: Management of idiopathic thrombocytopenic purpura during pregnancy. Am J Obstet Gynecol122 (1975) 182Search in Google Scholar
14 Laskin CA, C Bombardier, ME Hannah, FP Mandel, JW Ritchie, V Farewell, et al.: Prednisone and aspirin in women with autoantibodies and unexplained recurrent fetal loss. N Engl J Med337 (1997) 148Search in Google Scholar
15 Levine PR, RR Adams, A Silver, L Fernandez-Rocha: Idiopathic thrombocytopenic purpura, diabetes mellitus, and pregnancy. Obstet Gynecol48 (1976) 31Search in Google Scholar
16 Loukovaara MJ, S Loukovaara, PJ Leinonen, KA Teramo, SH Andersson: Endothelium-derived nitric oxide metabolites and soluble intercellular adhesion molecule-1 in diabetic and normal pregnancies. Eur J Obstet Gynecol Reprod Biol118 (2005) 160Search in Google Scholar
17 National Diabetes Data Group: Classification and diagnosis of gestational diabetes mellitus and other categories of glucose intolerance. Diabetes 28 (1979) 1039Search in Google Scholar
18 Ostensen M, R Ramsey-Goldman: Treatment of inflammatory rheumatic disorders in pregnancy: what are the safest treatment options? Drug Saf19 (1998) 389Search in Google Scholar
19 Peleg D, SK Hunter: Perinatal management of women with immune thrombocytopenic purpura: survey of United States perinatologists. Am J Obstet Gynecol180 (1999) 645Search in Google Scholar
20 Perlow JH, D Montgomery, MA Morgan, CV Towers, M Porto: Severity of asthma and perinatal outcome. Am J Obstet Gynecol167 (1992) 963Search in Google Scholar
21 Persson B, L Edwall, U Hanson, E Nord, M Westgren: Insulin sensitivity and insulin response in women with gestational diabetes mellitus. Horm Metab Res29 (1997) 393Search in Google Scholar
22 Vaquero E, N Lazzarin, H Valensise, S Menghini, G Di Pierro, F Cesa, et al.: Pregnancy outcome in recurrent spontaneous abortion associated with antiphospholipid antibodies: a comparative study of intravenous immunoglobulin versus prednisone plus low-dose aspirin. Am J Reprod Immunol45 (2001) 174Search in Google Scholar
23 Walsh SD, FR Clark: Pregnancy in patients on long-term corticosteroid therapy. Scott Med J12 (1967) 302Search in Google Scholar
24 Xiong X, LD Saunders, FL Wang, NN Demianczuk: Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. Int J Gynaecol Obstet75 (2001) 221Search in Google Scholar
25 Yamaguchi K, Y Ookubo, H Matsuda, K Suzaki, H Fukushima, H Uzawa: Idiopathic thrombocytopenic purpura subsequent to Graves' disease and insulin-dependent diabetes mellitus. Diabetes Res Clin Pract3 (1987) 233Search in Google Scholar
©2006 by Walter de Gruyter Berlin New York
Articles in the same Issue
- Advances in Perinatal Medicine - 5th Annual meeting of the Italian Society of Perinatal Medicine held in Parma, Italy on June 15th – 17th 2006
- Hemorrhagic shock in obstetrics
- Altered protease expression by periarterial trophoblast cells in severe early-onset preeclampsia with IUGR
- Gestational diabetes mellitus in patients receiving long-term corticosteroid therapy during pregnancy
- Accuracy and influence of ascorbic acid on glucose-test with urine dip sticks in prenatal care
- Protein C, protein S, and thrombomodulin in amniotic fluid. A preliminary study
- Timing of cord clamping revisited
- Intrapartum cardiotocography – the dilemma of interpretational variation
- Maturation of the autonomic nervous system: differences in heart rate variability in premature vs. term infants
- Four chamber view plus three-vessel and trachea view for a complete evaluation of the fetal heart during the second trimester
- Pleural fluid/serum immunoglobulin ratio is a diagnostic marker for congenital chylothorax in utero
- Fetal brain sparing is strongly related to the degree of increased placental vascular impedance
- Outcome of fetuses in women with pregestational diabetes mellitus
- Outcome of fetuses in women with pregestational diabetes mellitus
- Inhaled nitric oxide therapy might reduce the need for hyperventilation therapy in infants with persistent pulmonary hypertension of the newborn
- To drain or not to drain: a single institution experience with neonatal intestinal perforation
- Infective puerperal endocarditis caused by Escherichia coli
- Correlation between plasma and urinary caffeine levels in preterm infants
- Fetal ascites secondary to urinary hydrocolpos
- Congress Calendar
- Suppression of IL-2 and IFN-γ production in women with spontaneous preterm labor
Articles in the same Issue
- Advances in Perinatal Medicine - 5th Annual meeting of the Italian Society of Perinatal Medicine held in Parma, Italy on June 15th – 17th 2006
- Hemorrhagic shock in obstetrics
- Altered protease expression by periarterial trophoblast cells in severe early-onset preeclampsia with IUGR
- Gestational diabetes mellitus in patients receiving long-term corticosteroid therapy during pregnancy
- Accuracy and influence of ascorbic acid on glucose-test with urine dip sticks in prenatal care
- Protein C, protein S, and thrombomodulin in amniotic fluid. A preliminary study
- Timing of cord clamping revisited
- Intrapartum cardiotocography – the dilemma of interpretational variation
- Maturation of the autonomic nervous system: differences in heart rate variability in premature vs. term infants
- Four chamber view plus three-vessel and trachea view for a complete evaluation of the fetal heart during the second trimester
- Pleural fluid/serum immunoglobulin ratio is a diagnostic marker for congenital chylothorax in utero
- Fetal brain sparing is strongly related to the degree of increased placental vascular impedance
- Outcome of fetuses in women with pregestational diabetes mellitus
- Outcome of fetuses in women with pregestational diabetes mellitus
- Inhaled nitric oxide therapy might reduce the need for hyperventilation therapy in infants with persistent pulmonary hypertension of the newborn
- To drain or not to drain: a single institution experience with neonatal intestinal perforation
- Infective puerperal endocarditis caused by Escherichia coli
- Correlation between plasma and urinary caffeine levels in preterm infants
- Fetal ascites secondary to urinary hydrocolpos
- Congress Calendar
- Suppression of IL-2 and IFN-γ production in women with spontaneous preterm labor