ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Diabetes Care. 2020 Apr;43(4):906–908. doi: 10.2337/dc19-2126. Epub 2020 Jan 23. PMID: 31974101

Antenatal corticosteroid administration prior to planned cesarean section in early labour reduces by >50% the risk of admission to the neonatal intensive care unit for respiratory distress syndrome and transient tachypnea of the newborn. However, among pregnant women with gestational diabetes mellitus (GDM) or pre-existing diabetes, corticosteroid administration results in unpredictable maternal hyperglycemia, which is associated with neonatal hypoglycaemia. Therefore, it is unknown whether antenatal corticosteroid administration before planned cesarean section for early labour is beneficial among women with diabetes in pregnancy.

In this study, the authors compared the rates of neonatal respiratory distress syndrome, transient tachypnea of the newborn and neonatal hypoglycemia before and after the introduction of a clinical policy to avoid the use of corticosteroids before elective early cesarean section for pregnant women with diabetes. They observed that antenatal glucocorticoid administration was associated with higher risk of neonatal hypoglycemia, but no change in the rates of neonatal respiratory distress syndrome and transient tachypnea of the newborn. Based on these observations, the authors suggest that corticosteroids may be safely omitted in women with any form of diabetes in pregnancy undergoing early planned cesarean section. Such management could potentially significantly reduce admissions to the neonatal unit for neonatal hypoglycemia without increasing admissions for neonatal respiratory diseases. However, this single center study included a relatively small number of patients (90% with GDM). A larger randomized controlled trial would greatly strengthen this possibility.