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Am J Perinatol
DOI: 10.1055/a-2624-8405
SMFM Fellowship Series Article

Late Preterm Antenatal Corticosteroids in Pregestational and Gestational Diabetic Pregnancies

Lylach Haizler-Cohen 
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
,
Maria C. Alzamora
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
,
Nicole R. Legro
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
,
Leila Eter
2   Georgetown University School of Medicine, Washington, District of Columbia
,
Tasha Freed
2   Georgetown University School of Medicine, Washington, District of Columbia
,
Suditi Rahematpura
2   Georgetown University School of Medicine, Washington, District of Columbia
,
Ayah Arafat
3   MedStar Health Research Institute, Hyattsville, Maryland
,
Victoria Greenberg
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
,
Sara N. Iqbal
1   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
› Author Affiliations
Funding The Medstar Health Graduate Medical Education helped support the statistical analysis for this study.
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Abstract

Objective

This study aims to evaluate the association between late preterm antenatal corticosteroids (ACS) administration and the incidence of hypoglycemia and respiratory complications in neonates born to individuals with pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM).

Study Design

Multi-center retrospective cohort study between 2016 and 2022. Pregnant people with PGDM or GDM who presented in the late preterm period with concern for preterm delivery were included. The indication for admission was classified as preterm labor, preterm prelabor rupture of membranes, poorly controlled diabetes, or other maternal/fetal indications. Exclusion criteria included multifetal gestations, fetal anomalies, stillbirths, prior course of ACS, or no anticipation for delivery in the next 7 days. The primary outcome was neonatal hypoglycemia. Secondary outcomes included composite respiratory morbidity, composite nonrespiratory morbidity, neonatal intensive care unit (NICU) admission, length of NICU stay, and neonatal death. Multivariable regression models were used to calculate the odds ratio and 95% confidence intervals for the outcomes after adjusting for an indication for admission, gestational age at delivery, and neonatal birth weight. Outcome data were then stratified by diabetes type (PGDM vs. GDM) and completion status of the ACS course (partial vs. complete). For PGDM pregnancies, outcome data were additionally stratified by glycemic control.

Results

In the study period, 453 patients (126 with PGDM and 327 with GDM) were included. Of those, 265 (58.5%) received ACS, and 188 (41.5%) did not. There were no significant differences in neonatal hypoglycemia and composite respiratory morbidity between the ACS and non-ACS groups, including in the subgroup analysis of PGDM and GDM pregnancies. However, late preterm ACS was associated with reductions in supplemental oxygen use, mechanical ventilation, and respiratory distress syndrome when a complete course of ACS was administered. In PGDM pregnancies, neonatal outcomes did not differ between the ACS and non-ACS groups, regardless of glycemic control.

Conclusion

Late preterm ACS administration in diabetic pregnancies was not associated with increased neonatal hypoglycemia or improvements in composite respiratory morbidity.

Key Points

  • Late preterm steroids in diabetic pregnancies are not associated with neonatal hypoglycemia.

  • Composite respiratory morbidity is not improved in this setting.

  • Glycemic control does not impact neonatal outcomes with late preterm steroid use.

Keywords

pregestational - gestational - diabetes - antenatal - corticosteroids - late - preterm

Note

The findings of this study were presented in the clinical poster session at the 44th Annual Pregnancy Meeting by the Society for Maternal-Fetal Medicine, February 10th to 14th, 2024, in National Harbor, Maryland.


Authors' Contributions

V.G. and S.N.I. contributed equally to this work.




Publication History

Received: 28 February 2025

Accepted: 30 May 2025

Accepted Manuscript online:
02 June 2025

Article published online:
25 June 2025

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