Use of antenatal corticosteroids in pregnancies at late preterm gestation is increasing, yet evidence about efficacy and safety among women with diabetes in pregnancy is limited and inconsistent. The study aimed to separate the effects of maternal diabetes and the effects of antenatal corticosteroid administration before late preterm birth on adverse maternal and neonatal outcomes.
This was a population-based cohort study of women who delivered at gestational age ≥35 weeks between September 2016 and March 2021 in two local health districts in New South Wales, Australia. The investigators used routinely collected data from the participating districts to assemble the study cohort. The full-text source and its abstract report the study period, inclusion gestation threshold, and geographic setting.
Women were grouped into three mutually exclusive exposure categories for analysis:
A total of 5,067 women met inclusion criteria: 205 women in group 1, 4,028 in group 2, and 834 in group 3. The abstract does not provide subgroup counts for further stratification by diabetes type or by timing/dose of corticosteroids.
Women who received antenatal corticosteroids were more likely to have comorbid and obstetric features that distinguished them from those who did not receive corticosteroids. Specifically, corticosteroid recipients had higher proportions of:
These differences indicate that corticosteroid administration was more common in pregnancies with increased clinical complexity or indication for higher-level surveillance.
The investigators used modified Poisson regression to estimate adjusted relative risks (aRR) for outcomes of interest. Adjusted models and covariates used in those models are not detailed in the abstract; the effect estimates reported include adjusted relative risks with 95% confidence intervals for key neonatal outcomes.
According to the abstract, there were no differences in maternal outcomes between women with diabetes who received antenatal corticosteroids and women with diabetes who did not receive corticosteroids. The abstract does not list the specific maternal outcomes evaluated or their event rates; those details were not reported in the abstract provided.
The principal neonatal findings reported were as follows:
Among women with diabetes who received antenatal corticosteroids compared to women with diabetes who did not receive corticosteroids, the abstract reports no differences in maternal and neonatal outcomes overall.
When comparing women with diabetes who received corticosteroids to women without diabetes who received corticosteroids, the diabetic group had a higher risk of neonatal hypoglycaemia (aRR 1.61, 95% CI 1.28–2.02).
The same comparison showed higher risk of admission to nursery or neonatal intensive care unit (NICU) for infants of women with diabetes who received corticosteroids (aRR 1.18, 95% CI 1.02–1.38).
The abstract lists neonatal hypoglycaemia and neonatal intensive care unit admission as primary neonatal outcomes with statistically significant adjusted risks in those comparisons.
The authors conclude that there is limited evidence of benefit for administration of antenatal corticosteroids at late preterm gestations, regardless of maternal diabetes status. In this cohort, corticosteroid exposure in women with diabetes was not associated with improved maternal or neonatal outcomes compared with diabetic women not given corticosteroids, and was associated with higher risks of neonatal hypoglycaemia and nursery/NICU admission when compared with non-diabetic women who received corticosteroids.
The authors recommend further studies to identify any potential longer-term benefits or harms of antenatal corticosteroid use in late preterm gestations, particularly in the context of maternal diabetes.
The abstract does not report several details that are important for interpreting the findings, including:
Because these methodological and clinical details were not reported in the abstract, fuller appraisal requires consultation of the full text.
The authors declared no conflicts of interest in the report.
Note: This rewritten summary is based solely on the abstract and metadata available in the source record. Details not reported in the abstract have been identified as missing rather than inferred.