Neonatal outcomes following antenatal corticosteroid administration prior to elective caesarean delivery in women with pre‐gestational diabetes: A retrospective cohort study

Abstract

Background:The benefit of antenatal corticosteroid (ACS) administration for the prevention of neonatal morbidity and mortality has been well described for preterm infants. Some studies have demonstrated a benefit for infants born by elective caesarean section (CS) at late preterm or term gestations. However, the neonatal benefits of ACS are not well described when given to pregnant women with diabetes. Aims:The aim of this study was to evaluate the neonatal outcomes following ACS administration in women with pre-gestational diabetes mellitus (PGDM) when administered prior to elective CS after 36 weeks gestation.Methods: This retrospective observational study included all women with PGDM who gave birth by elective CS between 36 +0 and 38 +6 weeks gestation.Neonatal outcomes for exposed participants were compared to outcomes for non-exposed participants.Results: Of the 306 women identified, 65 (21.2%) were exposed to ACS within seven days prior to birth and 241 (78.8%) were not. Although not statistically significant, ACS-exposed infants born prior to 38 +0 weeks were less likely to require respiratory support or neonatal nursery admission compared to those who were not exposed; however, exposed infants born after 37 +0 weeks were more likely to require parenteral treatment for neonatal hypoglycaemia. Conclusion:This study did not demonstrate any statistically significant beneficial or harmful effects of ACS in neonates of women with PGDM who are born by elective CS. While it is plausible that ACS could reduce neonatal respiratory morbidity in this population, further prospective studies evaluating the benefits and harms are required before recommending this practice.

PRECeDe Pilot: Prevention of neonatal respiratory distress with antenatal corticosteroids before elective caesarean section in women with diabetes – a feasibility randomised trial

“…To conduct an RCT of a medication that is readily available but used in an ‘off‐label’ manner, it is important to limit the use of the medication in patients outside the context of the clinical trial. Before the commencement of the PRECeDe Pilot Trial, we reported that over 45% of women with PGDM received antenatal corticosteroids before elective CS at two tertiary maternity units during 2015 23 . An education campaign regarding the limited evidence for this intervention was undertaken.…”

“…Before the commencement of the PRECeDe Pilot Trial, we reported that over 45% of women with PGDM received antenatal corticosteroids before elective CS at two tertiary maternity units during 2015. 23 An education campaign regarding the limited evidence for this intervention was undertaken. Assessment of betamethasone use among women potentially eligible for the PRECeDe Pilot Trial but who were not recruited (or who declined to participate), demonstrated that only 3.5% received betamethasone between 35 +0 and 38 +6 weeks of gestation, outside this RCT.…”

Impact of Antenatal Corticosteroids on Glycemic Variations in Gestational Diabetes Mellitus: A Single Center Observational Study

“…32 An Australian study on 306 women documented that 21.2% of them received ACS within seven days of delivery via elective cesarian section. 36 Osteen et al 37 threatened abortion. In our study, ACS was given to those with threatened preterm delivery.…”