Oral Presentation Australasian Diabetes in Pregnancy Society Annual Scientific Meeting 2019

Direct Fetal Intramuscular Betamethasone Injection as an Alternative Approach for Women with Type 1 Diabetes Mellitus at Risk of Preterm Birth: a Case Series (#36)

Amanda J Poprzeczny 1 2 , Chris Wilkinson 1 , Jodie M Dodd 1 2
  1. Women's and Children's Hospital, North Adelaide, SOUTH AUSTRALIA, Australia
  2. Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia

Introduction:

Women who have type 1 diabetes mellitus are at an increased risk of preterm delivery. These women are also at an increased risk of requiring delivery by planned late preterm or early term caesarean section. Recent evidence of a beneficial effect of antenatal corticosteroids prior to late preterm birth, and subsequent college guidelines recommending their use in this population, has resulted in a widening of the population of women who are being prescribed antenatal corticosteroids. Women with type 1 diabetes mellitus have traditionally been excluded from studies of antenatal corticosteroids for preterm birth, resulting in a lack of evidence on effectiveness and safety in this population. In our centre, women thought to be at particularly high risk of adverse effects from traditional antenatal corticosteroids (i.e. maternal intramuscular betamethasone) are considered for an alternative – direct fetal intramuscular betamethasone, delivered into the fetal thigh in utero. We present a series of these cases, the indications, neonatal outcomes, and maternal blood glucose profiles associated with this novel approach. 

 

Methods:

Retrospective case note audit of women with type 1 diabetes mellitus who underwent direct fetal intramuscular betamethasone injection prior to preterm birth or planned caesarean section.

 

Results:

Twelve women with type 1 diabetes mellitus underwent direct fetal intramuscular betamethasone injection in utero. Glycosylated haemoglobin at booking ranged from 5.9-11.1%. All but two women had evidence of diabetic fetopathy on serial ultrasound growth scans. Gestation at delivery ranged from 34+1 to 37+3 weeks, with direct fetal intramuscular betamethasone given 1-4 days prior. The intervention did not appreciably affect maternal blood sugar profiles, as compared to blood sugar profiles prior to fetal injection.

 

Discussion:

We present a novel approach to providing antenatal corticosteroids to fetuses at risk of preterm delivery, with minimal effect on maternal blood sugar levels. Further research is required.