Department of Maternal Fetal Medicine, The Royal Women's Hospital, Melbourne, Victoria, Australia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Aust N Z J Obstet Gynaecol. 2023 Feb;63(1):93-98. doi: 10.1111/ajo.13586. Epub 2022 Jul 27.
The benefit of antenatal corticosteroid (ACS) administration for the prevention of neonatal morbidity and mortality has been well described for preterm infants. Some studies have demonstrated a benefit for infants born by elective caesarean section (CS) at late preterm or term gestations. However, the neonatal benefits of ACS are not well described when given to pregnant women with diabetes.
The aim of this study was to evaluate the neonatal outcomes following ACS administration in women with pre-gestational diabetes mellitus (PGDM) when administered prior to elective CS after 36 weeks gestation.
This retrospective observational study included all women with PGDM who gave birth by elective CS between 36 and 38 weeks gestation. Neonatal outcomes for exposed participants were compared to outcomes for non-exposed participants.
Of the 306 women identified, 65 (21.2%) were exposed to ACS within seven days prior to birth and 241 (78.8%) were not. Although not statistically significant, ACS-exposed infants born prior to 38 weeks were less likely to require respiratory support or neonatal nursery admission compared to those who were not exposed; however, exposed infants born after 37 weeks were more likely to require parenteral treatment for neonatal hypoglycaemia.
This study did not demonstrate any statistically significant beneficial or harmful effects of ACS in neonates of women with PGDM who are born by elective CS. While it is plausible that ACS could reduce neonatal respiratory morbidity in this population, further prospective studies evaluating the benefits and harms are required before recommending this practice.
产前皮质类固醇（ACS）的应用对于预防早产儿的发病率和死亡率已得到充分证实。一些研究表明，对于晚期早产或足月剖宫产（CS）分娩的婴儿也有获益。然而，对于患有糖尿病的孕妇，ACS 对新生儿的益处尚未得到很好的描述。
本研究旨在评估患有孕前糖尿病（PGDM）的孕妇在妊娠 36 周后择期 CS 前应用 ACS 对新生儿结局的影响。
本回顾性观察性研究纳入了所有在 36 至 38 周之间择期 CS 分娩的 PGDM 妇女。将暴露组和非暴露组的新生儿结局进行比较。
在 306 名被识别的妇女中，有 65 名（21.2%）在分娩前 7 天内接受了 ACS，241 名（78.8%）未接受。尽管没有统计学意义，但与未暴露组相比，ACS 暴露组在 38 周前出生的婴儿更有可能不需要呼吸支持或新生儿病房入院；然而，在 37 周后出生的 ACS 暴露组婴儿更有可能需要接受静脉注射葡萄糖治疗新生儿低血糖。
本研究未发现 ACS 对接受择期 CS 的 PGDM 妇女所产新生儿有任何统计学上显著的有益或有害影响。虽然 ACS 可能会降低该人群的新生儿呼吸发病率，但在推荐这种做法之前，需要进一步进行前瞻性研究来评估其获益和风险。
