Liggins Institute, University of Auckland, Auckland, New Zealand.
PLoS One. 2020 Feb 27;15(2):e0229014. doi: 10.1371/journal.pone.0229014. eCollection 2020.
Antenatal corticosteroids administered to the mother prior to birth decrease the risk of mortality and major morbidity in infants born at less than 35 weeks' gestation. However, the evidence relating to women with diabetes in pregnancy is limited. Clinical guidelines for antenatal corticosteroid administration recommend that women with diabetes in pregnancy are treated in the same way as women without diabetes, but there are no recent descriptions of whether contemporary practice complies with this guidance. This study is a retrospective review of antenatal corticosteroid administration at a New Zealand tertiary hospital in women with diabetes in pregnancy. We found that in this cohort, for both an initial course at less than 35 weeks' gestation and repeat courses at less than 33 weeks', the administration of antenatal corticosteroid to women with diabetes in pregnancy is largely consistent with current Australian and New Zealand recommendations. However, almost 25% of women received their last dose of antenatal corticosteroid at or beyond the latest recommended gestation of 35 weeks' gestation. Pre-existing diabetes and planned caesarean section were independently associated with an increased rate of antenatal corticosteroid administration. We conclude that diabetes in pregnancy does not appear to be a deterrent to antenatal corticosteroid administration. The high rates of administration at gestations beyond recommendations, despite the lack of evidence of benefit in this group of women, highlights the need for further research into the risks and benefits of antenatal corticosteroid administration to women with diabetes in pregnancy, particularly in the late preterm and early term periods.
产前皮质类固醇在孕妇分娩前给予，可以降低妊娠 35 周前出生的婴儿的死亡率和主要发病率。然而，与妊娠糖尿病相关的证据有限。产前皮质类固醇给药的临床指南建议，妊娠糖尿病的妇女应采用与非糖尿病妇女相同的方式治疗，但最近没有描述当代实践是否符合这一指导原则。本研究是对新西兰一家三级医院妊娠糖尿病妇女产前皮质类固醇给药的回顾性分析。我们发现，在这组人群中，无论是在妊娠 35 周前的初始疗程，还是在妊娠 33 周前的重复疗程中，妊娠糖尿病妇女接受产前皮质类固醇治疗在很大程度上符合澳大利亚和新西兰的现行建议。然而，近 25%的妇女在推荐的最晚妊娠 35 周后或在该时间点接受了最后一剂产前皮质类固醇。预先存在的糖尿病和计划剖腹产与产前皮质类固醇给药率的增加独立相关。我们的结论是，妊娠糖尿病似乎并不是产前皮质类固醇给药的障碍。尽管在这组妇女中缺乏益处的证据，但在推荐的妊娠时间之外仍有较高的给药率，这突出表明需要进一步研究妊娠糖尿病妇女接受产前皮质类固醇的风险和益处，特别是在晚期早产儿和早期足月产期间。
