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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
› Institutsangaben
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.




Publikationsverlauf

Eingereicht: 28. Februar 2025

Angenommen: 30. Mai 2025

Accepted Manuscript online:
02. Juni 2025

Artikel online veröffentlicht:
25. Juni 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972; 50 (04) 515-525
    Suche in Google Scholar
  • 2 Crowley P, Chalmers I, Keirse MJ. The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials. Br J Obstet Gynaecol 1990; 97 (01) 11-25
    Suche in Google Scholar
  • 3 Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3 (03) CD004454
    Suche in Google Scholar
  • 4 Gyamfi-Bannerman C, Thom EA. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med 2016; 375 (05) 486-487
    Suche in Google Scholar
  • 5 Reddy UM, Deshmukh U, Dude A, Harper L, Osmundson SS. Society for Maternal-Fetal Medicine (SMFM). Electronic address: pubs@smfm.org. Society for Maternal-fetal Medicine consult series #58: use of antenatal corticosteroids for individuals at risk for late preterm delivery: replaces SMFM statement #4, implementation of the use of antenatal corticosteroids in the late preterm birth period in women at risk for preterm delivery, August 2016. Am J Obstet Gynecol 2021; 225 (05) B36-B42
    Suche in Google Scholar
  • 6 Clapp MA, Melamed A, Freret TS, James KE, Gyamfi-Bannerman C, Kaimal AJ. US incidence of late-preterm steroid use and associated neonatal respiratory morbidity after publication of the antenatal late preterm steroids trial, 2015-2017. JAMA Netw Open 2022; 5 (05) e2212702
    Suche in Google Scholar
  • 7 Robert MF, Neff RK, Hubbell JP, Taeusch HW, Avery ME. Association between maternal diabetes and the respiratory-distress syndrome in the newborn. N Engl J Med 1976; 294 (07) 357-360
    Suche in Google Scholar
  • 8 Battarbee AN, Clapp MA, Boggess KA. et al. Practice variation in antenatal steroid administration for anticipated late preterm birth: a physician survey. Am J Perinatol 2019; 36 (02) 200-204
    Suche in Google Scholar
  • 9 ACOG practice bulletin no. 190: gestational diabetes mellitus. Obstet Gynecol 2018; 131 (02) e49-e64
    Suche in Google Scholar
  • 10 American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 101: ultrasonography in pregnancy. Obstet Gynecol 2009; 113 (2 Pt 1): 451-461
    Suche in Google Scholar
  • 11 American Diabetes Association. . 13. Management of diabetes in pregnancy: standards of medical care in diabetes-2018. Diabetes Care 2018; 41 (Suppl. 01) S137-S143
    Suche in Google Scholar
  • 12 Dude AM, Yee LM, Henricks A, Eucalitto P, Badreldin N. Neonatal hypoglycemia after antenatal late preterm steroids in individuals with diabetes. J Perinatol 2021; 41 (12) 2749-2753
    Suche in Google Scholar
  • 13 Raj-Derouin N, Perino JM, Fisher S, Zhang Y, Thaker V, Zork NM. Neonatal hypoglycemia following late preterm antenatal corticosteroid administration in individuals with diabetes in pregnancy. Am J Perinatol 2024; 41 (S01): e2927-e2933
    Suche in Google Scholar
  • 14 Cassimatis IR, Battarbee AN, Allshouse AA. et al. Neonatal outcomes associated with late preterm betamethasone administration in women with pregestational diabetes. Pediatr Neonatol 2020; 61 (06) 645-646
    Suche in Google Scholar
  • 15 Li X, Zhang J, Hao Q, Du Y, Cheng X. The effect of time interval between antenatal corticosteroid administration and delivery on outcomes in late preterm neonates born to mothers with diabetes: a retrospective cohort study. Front Pediatr 2023; 11: 1239977
    Suche in Google Scholar
  • 16 McElwee ER, Wilkinson K, Crowe R. et al. Latency of late preterm steroid administration to delivery and risk of neonatal hypoglycemia. Am J Obstet Gynecol MFM 2022; 4 (05) 100687
    Suche in Google Scholar
  • 17 Onishi K, Huang JC, Saade GR, Kawakita T. Post antenatal late preterm steroids trial: interrupted time series analysis of respiratory outcomes in twin and pregestational diabetes. Am J Obstet Gynecol MFM 2023; 5 (08) 101041
    Suche in Google Scholar
  • 18 Khanuja K, Jayakumaran J, Al-Kouatly HB, McLaren Jr RA. Antenatal steroids and neonatal outcomes in late preterm births with pregestational diabetes. Int J Gynaecol Obstet 2024; 166 (02) 767-774
    Suche in Google Scholar
  • 19 Robertson B. Corticosteroids and surfactant for prevention of neonatal RDS. Ann Med 1993; 25 (03) 285-288
    Suche in Google Scholar
  • 20 Warburton D. Chronic hyperglycemia with secondary hyperinsulinemia inhibits the maturational response of fetal lamb lungs to cortisol. J Clin Invest 1983; 72 (02) 433-440
    Suche in Google Scholar
  • 21 Kawakita T, Bowers K, Hazrati S. et al. Increased neonatal respiratory morbidity associated with gestational and pregestational diabetes: a retrospective study. Am J Perinatol 2017; 34 (11) 1160-1168
    Suche in Google Scholar
  • 22 Hamm RF, Combs CA, Aghajanian P, Friedman AM. Society for Maternal-Fetal Medicine (SMFM). Electronic address: smfm@smfm.org, Patient Safety and Quality Committee. Society for maternal-fetal medicine special statement: quality metrics for optimal timing of antenatal corticosteroid administration. Am J Obstet Gynecol 2022; 226 (06) B2-B10
    Suche in Google Scholar
  • 23 Finneran MM, Kiefer MK, Ware CA. et al. The use of longitudinal hemoglobin A1C values to predict adverse obstetric and neonatal outcomes in pregnancies complicated by pregestational diabetes. Am J Obstet Gynecol MFM 2020; 2 (01) 100069
    Suche in Google Scholar
  • 24 American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: standards of care in diabetes-2024. Diabetes Care 2024; 47 (Suppl. 01) S20-S42
    Suche in Google Scholar
  • 25 Melamed N, Shah J, Soraisham A. et al. Association between antenatal corticosteroid administration-to-birth interval and outcomes of preterm neonates. Obstet Gynecol 2015; 125 (06) 1377-1384
    Suche in Google Scholar