Corticosteroid use during pregnancy not associated with gestational diabetes risk overall
Gestational diabetes risk was only increased if oral corticosteroid exposure occurred during the fourth to sixth week of pregnancy, not during other time periods, according to an analysis of more than one million pregnancies in Korea.
Oral corticosteroid use during pregnancy was not associated with an increased risk of gestational diabetes, except for a modest increase in risk among women taking steroids between four and six weeks' gestation, a cohort study in Korea found.
To assess the risk of gestational diabetes associated with oral corticosteroid use during pregnancy, researchers analyzed 1,325,940 pregnancies resulting in live births in Korea from 2010 through 2021. Steroid exposure was measured in three-week intervals between one and 27 weeks' gestation. Findings were published by JAMA Internal Medicine on Dec. 1.
Of the included pregnancies, 79,710 (6.0%) were exposed to oral steroids between one and 27 weeks' gestation. Steroid exposure was not associated with an increased risk of gestational diabetes in most intervals, but exposure between four and six weeks' gestation was the exception (weighted risk ratio [RR], 1.10; 95% CI, 1.03 to 1.17). In pooled analyses, gestational diabetes occurred in 9.50% (95% CI, 9.26% to 9.74%) of pregnancies among women in the exposed group compared with 7.36% (95% CI, 7.31% to 7.43%) of pregnancies in the unexposed group (weighted RR, 1.01; 95% CI, 0.99 to 1.03). There were no significant differences by maternal age, indication for steroid usage, or duration of action or exposure, dosage, or timing of the drug.
The slightly increased risk of gestational diabetes associated with exposure in weeks four to six underscores “the importance of considering early gestational exposures and highlight[s] the need for further research into mechanisms underlying gestational diabetes development during this vulnerable period,” the study authors wrote.
Limitations include that gestational diabetes diagnoses relied on diagnostic codes without laboratory confirmation and that the study only included pregnancies that resulted in live births.
Overall, “results are reassuring for clinicians managing chronic inflammatory or autoimmune conditions during pregnancy, when corticosteroid therapy may be essential for maternal and fetal well-being,” the authors concluded.