Late Preterm Antenatal Corticosteroids in Pregestational and Gestational Diabetic Pregnancies

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