Use oral corticosteroids in Pregnancy not tied to Increased Gestational Diabetes Risk: JAMA

This cohort study used a national, population-based sample that initially included 3,848,270 pregnancies, of which 1,325,940 met all eligibility criteria. Exposure to OCSs was evaluated in 3-week windows using a sequential landmark analysis to reduce time-related biases. Of the total number, 79,710 pregnancies (6.0%) were exposed to OCSs during early to mid-pregnancy. Gestational diabetes was ascertained starting at 20 weeks + 1 day through delivery using a well-validated claims-based algorithm. The authors performed propensity score–based overlap weighting to reduce confounding, including maternal comorbidities, concomitant medications, and patterns of health care use.

Results

• In the majority of time windows, OCS exposure did not significantly increase the risk of gestational diabetes, except in the 4–6-week gestational interval.

• The corresponding weighted RR was 1.10 (95% CI, 1.03–1.17). In a pooled analysis, the incidence of gestational diabetes was 9.50% (95% CI, 9.26%–9.74%) in pregnancies exposed to OCSs and 7.36% (95% CI, 7.31%–7.43%) in unexposed pregnancies.

• However, the weighted overall pooled RR after full adjustment was 1.01 (95% CI, 0.99–1.03), indicating no clinically significant effect.

• Overall, subgroup analyses for maternal age, indication of the underlying condition, corticosteroid duration of action, dose, timing of exposure, or cumulative exposure duration showed no significant effect modification.

This large, population-based study demonstrated that oral corticosteroid exposure during pregnancy did not increase the overall risk of gestational diabetes, aside from a small elevation in risk for exposure occurring between 4 and 6 weeks' gestation.

Reference:

Choi E, Cho Y, Oh J, Choi A, Kim H, Shin J. Oral Corticosteroid Use During Pregnancy and the Risk of Gestational Diabetes. JAMA Intern Med. Published online December 01, 2025. doi:10.1001/jamainternmed.2025.6367