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Diabetes and Vascular Disease

SAT-521 - Glycemic Responses and Management Strategies Following Antenatal Corticosteroid Administration in Gestational Diabetes: A Systematic Review

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT


Background: Antenatal corticosteroids (ACS) are administered to accelerate fetal lung maturation in pregnant individuals at risk of preterm delivery. Betamethasone is most commonly used and is typically delivered as two 12 mg intramuscular doses 24 hours apart. However, in individuals with gestational diabetes mellitus (GDM), ACS present unique challenges due to their hyperglycemic effects, which can destabilize maternal glycemic control and contribute to adverse neonatal outcomes. Current clinical guidelines provide limited direction on optimal management strategies.

Objectives: To synthesize evidence on glycemic responses and management strategies following betamethasone exposure in individuals with GDM.

Methods: A comprehensive search of Embase, MEDLINE, and CENTRAL was conducted in October 2025 in accordance with PRISMA guidelines. Studies reporting glycemic outcomes and/or management strategies following betamethasone exposure in individuals with GDM were included from database inception. Risk of bias was assessed using the Cochrane Risk of Bias tool or the Newcastle-Ottawa Scale.

Results: A total of 16 studies met inclusion criteria. Maternal glycemia rose predictably following betamethasone administration, with hyperglycemia typically emerging within 9-16 hours, peaking over the subsequent 24-72 hours, and often persisting for up to 5 days. Among individuals managed with medical nutrition therapy or oral hypoglycemic agents at baseline, subcutaneous insulin initiation ranged from 13% to 91%. Among those receiving subcutaneous insulin at baseline, 67% to 88% required dose escalation, with mean increases typically ranging from 47% to 91%. Some studies reported substantially greater increases, exceeding 300% over the study periods. Pregnancy-adapted intravenous insulin (IVI) protocols were associated with lower mean glycemia, higher time-in-range, and fewer hyperglycemic and hypoglycemic events compared to general adult IVI pathways. However, limited evidence suggests that structured, pregnancy-specific subcutaneous insulin protocols may achieve comparable or improved glycemic control. Risk of bias assessment identified 4 studies (25%) as low risk, 8 (50%) as having some concerns, and 4 (25%) as high risk.

Conclusions: ACS exposure in GDM is associated with a reproducible and predictable temporal pattern of deterioration in glycemic control. Existing guidelines are largely extrapolated from other diabetes populations and remain reactive. GDM-specific evidence suggests that management may benefit from a more proactive approach, including structured monitoring and the use of pregnancy-adapted subcutaneous or IVI protocols to attenuate hyperglycemia. Further prospective studies are required to define standardized, GDM-specific management strategies.

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