Maternal glycaemic responses to antenatal glucocorticoids: a scoping review

Abstract

Background: Antenatal glucocorticoids are associated with significant transient hyperglycaemia in women with diabetes, however, the glycaemic effects of antenatal glucocorticoids for women without diabetes and their neonates are unknown.

Objectives: To investigate the maternal glycaemic effects of antenatal glucocorticoids administered for fetal lung maturation in women without diabetes, as well as the association between maternal glycaemia and neonatal hypoglycaemia.

Study design: A systematic search was performed in May 2025 using the Ovid Medline and Embase data bases to identify relevant studies reporting glycaemic outcomes for women without diabetes receiving antenatal glucocorticoids. The key outcome of interest was maternal glycaemic patterns; secondary outcomes included the prevalence of neonatal hypoglycaemia as well as factors that may predict maternal hyperglycaemia.

Results: There were 14 studies that met the inclusion criteria, comprising 12 cohort studies and 2 randomised controlled trials. All studies unanimously reported maternal hyperglycaemia following the administration of either betamethasone or dexamethasone in women without diabetes, with a prevalence of 54-95 %. While three studies utilised insulin to manage maternal hyperglycaemia, dosages varied significantly, and the impact of treatment on maternal and neonatal outcomes remains unclear.

Conclusions: Maternal hyperglycaemia is highly prevalent following antenatal glucocorticoids in women without diabetes; however, it is currently unclear whether this is associated with adverse outcomes including neonatal hypoglycaemia. There is currently insufficient data to support monitoring or management of hyperglycaemia in patients without diabetes receiving antenatal glucocorticoids, however, given the extent and duration of hyperglycaemia documented, large multi-centre trials are required to inform clinical practice.

Keywords: Antenatal glucocorticoids; Betamethasone; Diabetes in pregnancy; Gestational diabetes; Maternal hyperglycaemia; Neonatal hypoglycaemia.