TOPLINE

Women with diabetes who received antenatal corticosteroids prior to late preterm birth experienced no differences in maternal or neonatal outcomes compared to women with diabetes who did not receive corticosteroids. Among women who received corticosteroids, those with diabetes had a higher risk for neonatal hypoglycemia and nursery or ICU admission compared to women without diabetes.

METHODOLOGY

• Researchers conducted a cohort study of 5067 women who gave birth at ≥ 35 weeks' gestation between September 2016 and March 2021 in 2 local health districts in New South Wales, Australia.
• Women were grouped into 3 categories: 205 with diabetes who received antenatal corticosteroids, 4028 with diabetes who did not receive corticosteroids, and 834 without diabetes who received corticosteroids.
• The mean age of the cohorts ranged from 31.9-34.3 years.
• Diabetes included both pre-gestational (type 1, type 2) and gestational diabetes diagnosed according to International Association of the Diabetes and Pregnancy Study Group criteria.
• Maternal outcomes included maternal postpartum hemorrhage and infection; neonatal outcomes included jaundice, hypoglycemia (blood glucose < 2.6 mmol/L), respiratory distress, admission to NICU or special care nursery, stillbirth, and neonatal death.

TAKEAWAY

• After adjusting for potential confounders, women with diabetes who received antenatal corticosteroids showed no statistically significant differences in any maternal or neonatal outcomes compared to women with diabetes who did not receive corticosteroids.
• Among women who received corticosteroids, those with diabetes had a 61% higher risk for neonatal hypoglycemia (adjusted relative risk [aRR], 1.61; 95% CI, 1.28-2.02) compared to women without diabetes.
• Women with diabetes who received corticosteroids had an 18% higher risk for infant admission to special care nursery or NICU (aRR, 1.18; 95% CI, 1.02-1.38) compared to women without diabetes who received corticosteroids.

IN PRACTICE

"These findings underscore the importance of robust evidence to guide treatment plans and to understand which patients may benefit from antenatal corticosteroids. Clinicians should weigh the benefits of antenatal corticosteroids in improving fetal lung maturity against the potential for increased neonatal complications, particularly in late preterm to early term deliveries," the authors wrote.

SOURCE

The study was led by Ibinabo Ibiebele, Reproduction and Perinatal Centre – Northern Precinct, Faculty of Medicine and Health, the University of Sydney, Sydney, New South Wales, Australia. It was published online on July 28 in The Australian & New Zealand Journal of Obstetrics & Gynaecology.

LIMITATIONS

The study lacked data on glycemic control during pregnancy and management of maternal hyperglycemia in the corticosteroid groups. The group receiving antenatal corticosteroids was fundamentally different from the group that did not receive antenatal corticosteroids. The study did not include the full range of late preterm births (34-36 weeks).

DISCLOSURES

The study was supported by grants from the National Health and Medical Research Council, the NSW Ministry of Health, the Royal North Shore Hospital No. 2 Trust Fund Research Registrar Funding, the Australian Diabetes Society, and the Douglas and Lola Douglas Scholarship. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.