Impacts of Tocolytics on Maternal and Neonatal Glucose Levels in Women With Gestational Diabetes Mellitus.
Publication Title
Journal of Korean medical science
Document Type
Article
Publication Date
9-2-2024
Keywords
california; eureka; Humans; Female; Pregnancy; Diabetes, Gestational; Tocolytic Agents; Blood Glucose; Retrospective Studies; Adult; Nifedipine; Infant, Newborn; Hypoglycemia; Ritodrine; Vasotocin; Logistic Models; Hyperglycemia; Odds Ratio; Obstetric Labor, Premature; Pregnancy Outcome; Republic of Korea
Abstract
Background: We investigated the impacts of tocolytic agents on maternal and neonatal blood glucose levels in women with gestational diabetes mellitus (GDM) who used tocolytics for preterm labor.
Methods: This multi-center, retrospective cohort study included women with GDM who were admitted for preterm labor from twelve hospitals in South Korea. We excluded women with multiple pregnancies, anomalies, overt DM diagnosed before pregnancy or 23 weeks of gestation, and women who received multiple tocolytics. The patients were divided according to the types of tocolytics; atosiban, ritodrine, and nifedipine group. We collected baseline maternal characteristics, pregnancy outcomes, maternal glucose levels during hospitalization, and neonatal glucose levels. We compared the frequency of maternal hyperglycemia and neonatal hypoglycemia among three groups. A multivariate logistic regression analysis was performed to evaluate the contributing factors to the occurrence of maternal hyperglycemia and neonatal hypoglycemia.
Results: A total of 128 women were included: 44 (34.4%), 51 (39.8%), and 33 (25.8%) women received atosiban, ritodrine, and nifedipine, respectively. Mean fasting blood glucose (FBG) (112.3, 109.6, and 89.5 mg/dL, P < 0.001) and 2-hour postprandial glucose (PPG2) levels (145.4, 148.3, and 116.5 mg/dL, P = 0.004) were significantly higher in atosiban and ritodrine group than those in nifedipine group. Even after adjusting for covariates including antenatal steroid use, gestational age at admission, and pre-pregnancy body mass index, there was an increased risk of high maternal mean FBG (≥ 95 mg/dL) and PPG2 (≥ 120 mg/dL) levels in the atosiban and ritodrine group than in nifedipine group. The atosiban and ritodrine groups are also at increased risk of neonatal hypoglycemia (< 47 mg/dL) compared to the nifedipine group with the odds ratio of 4.58 and 4.67, respectively (P < 0.05).
Conclusion: There is an increased risk of maternal hyperglycemia and neonatal hypoglycemia in women with GDM using atosiban and ritodrine tocolytics for preterm labor compared to those using nifedipine.
Keywords: Atosiban; Gestational Diabetes; Maternal Hyperglycemia; Neonatal Hypoglycemia; Nifedipine; Ritodrine.
Area of Special Interest
Women & Children
Area of Special Interest
Kidney & Diabetes
Specialty/Research Institute
Obstetrics & Gynecology
Specialty/Research Institute
Endocrinology
Specialty/Research Institute
Perinatology/Neonatology
DOI
10.3346/jkms.2024.39.e236
