Antenatal Corticosteroids in Gestational Diabetes: A Systematic Review of Glycemic Response and Management Strategies
10 affiliations
- 1Department of Medicine McGill University Montreal Quebec Canada
- 2Faculty of Medicine Université de Montréal Montreal Quebec Canada
- 3Faculty of Medicine Université de Sherbrooke Sherbrooke Quebec Canada
- 4Faculty of Medicine McGill University Montreal Quebec Canada
- 5Division of Endocrinology and Metabolism McGill University Health Centre Montreal Quebec Canada
- 6Division of Endocrinology and Metabolism Jewish General Hospital Montreal Quebec Canada
- 7Division of Endocrinology and Metabolism Centre hospitalier de l'Université de Montréal (CHUM) and Research Center of the Centre hospitalier de l'Université de Montréal (CR‐CHUM) Montreal Quebec Canada
- 8Centre for Outcomes Research and Evaluation Research Institute of the McGill University Health Centre Montreal Quebec Canada
- 9School of Human Nutrition McGill University Montreal Quebec Canada
- 10Lady Davis Institute for Medical Research, Centre for Clinical Epidemiology McGill University Montreal Quebec Canada
Abstract
Background: Antenatal corticosteroids (ACS) promote foetal lung maturation in pregnancies at risk of preterm birth; however, in gestational diabetes mellitus (GDM), they can exacerbate maternal glycemia and contribute to adverse neonatal outcomes. Clinical guidelines offer limited direction on optimal treatment adjustment.
Objectives: To synthesize the evidence on glycaemic responses and management strategies following ACS exposure in individuals with GDM.
Methods: A systematic review of Embase, MEDLINE and CENTRAL in October 2025 in accordance with PRISMA guidelines. Studies reporting on glycaemic outcomes and/or management strategies following ACS exposure in individuals with GDM were included.
Results: Twenty studies were included. Maternal glycemia rose predictably after ACS, with hyperglycaemia typically emerging within 9–16 h, peaking over the subsequent 24–72 h and often persisting up to 5 days. Among individuals managed with medical nutrition therapy or oral hypoglycaemic agents at baseline, insulin initiation ranged from 13% to 91%. Among those already using insulin, 67%–88% required dose escalation, with mean increases typically ranging from 47% to 91%. Pregnancy‐adapted intravenous insulin (IVI) pathways reported higher time‐in‐range and fewer hyperglycaemic/hypoglycaemic events than adult IVI protocols. However, emerging evidence suggests that structured, pregnancy‐specific subcutaneous insulin protocols may achieve comparable or improved glycaemic control.
Conclusions: ACS exposure in GDM is associated with a predictable but variable, transient deterioration in maternal glycaemia. GDM‐specific evidence suggests that structured pregnancy‐adapted monitoring and insulin‐adjustment pathways may help attenuate post‐ACS hyperglycaemia. However, the evidence remains heterogeneous and largely observational. Prospective studies are needed to validate GDM‐specific algorithms, clarify thresholds for insulin initiation or escalation and define indications for subcutaneous versus IVI.
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BibTeX
@article{katz2026antenatal,
title = {{Antenatal Corticosteroids in Gestational Diabetes: A Systematic Review of Glycemic Response and Management Strategies}},
author = {Alexandra Katz and Aidan Shulkin and Samantha Jacobson and Chella Price and Michael A. Tsoukas and Isabella Albanese and Agnieszka Majdan and Jill Pancer and Ariane Godbout and Kaberi Dasgupta and Anne‐Sophie Brazeau and Tricia Peters},
journal = {Diabetes, Obesity \& Metabolism},
year = {2026},
month = sep,
doi = {10.1111/dom.71311},
url = {https://doi.org/10.1111/dom.71311},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Antenatal Corticosteroids in Gestational Diabetes: A Systematic Review of Glycemic Response and Management Strategies
AU - Alexandra Katz
AU - Aidan Shulkin
AU - Samantha Jacobson
AU - Chella Price
AU - Michael A. Tsoukas
AU - Isabella Albanese
AU - Agnieszka Majdan
AU - Jill Pancer
AU - Ariane Godbout
AU - Kaberi Dasgupta
AU - Anne‐Sophie Brazeau
AU - Tricia Peters
PY - 2026
DA - 2026/09/09
JO - Diabetes, Obesity & Metabolism
DO - 10.1111/dom.71311
UR - https://doi.org/10.1111/dom.71311
AB - Background: Antenatal corticosteroids (ACS) promote foetal lung maturation in pregnancies at risk of preterm birth; however, in gestational diabetes mellitus (GDM), they can exacerbate maternal glycemia and contribute to adverse neonatal outcomes. Clinical guidelines offer limited direction on optimal treatment adjustment. Objectives: To synthesize the evidence on glycaemic responses and management strategies following ACS exposure in individuals with GDM. Methods: A systematic review of Embase, MEDLINE and CENTRAL in October 2025 in accordance with PRISMA guidelines. Studies reporting on glycaemic outcomes and/or management strategies following ACS exposure in individuals with GDM were included. Results: Twenty studies were included. Maternal glycemia rose predictably after ACS, with hyperglycaemia typically emerging within 9–16 h, peaking over the subsequent 24–72 h and often persisting up to 5 days. Among individuals managed with medical nutrition therapy or oral hypoglycaemic agents at baseline, insulin initiation ranged from 13% to 91%. Among those already using insulin, 67%–88% required dose escalation, with mean increases typically ranging from 47% to 91%. Pregnancy‐adapted intravenous insulin (IVI) pathways reported higher time‐in‐range and fewer hyperglycaemic/hypoglycaemic events than adult IVI protocols. However, emerging evidence suggests that structured, pregnancy‐specific subcutaneous insulin protocols may achieve comparable or improved glycaemic control. Conclusions: ACS exposure in GDM is associated with a predictable but variable, transient deterioration in maternal glycaemia. GDM‐specific evidence suggests that structured pregnancy‐adapted monitoring and insulin‐adjustment pathways may help attenuate post‐ACS hyperglycaemia. However, the evidence remains heterogeneous and largely observational. Prospective studies are needed to validate GDM‐specific algorithms, clarify thresholds for insulin initiation or escalation and define indications for subcutaneous versus IVI.
SN - 1462-8902
SN - 1463-1326
ER -