(1017) Late preterm antenatal steroids in women with gestational diabetes mellitus

Objective: Pregnant people with gestational diabetes mellitus (GDM) were included in the ALPS study but represented only 11% of the sample. Additionally, neonatal outcomes were not stratified based on maternal diabetes status. The objective of this study was to examine the rate of neonatal hypoglycemia, NICU admission, and respiratory morbidity in neonates of pregnant individuals with GDM who were exposed to late preterm antenatal steroids (AS) and those who were not.

Study Design: This was a retrospective cohort study in four hospitals in one healthcare system between 2016-2021. Pregnant people with either GDMA1 (diet controlled) or GDMA2 (requiring medication) who presented in the late preterm period with concern for preterm delivery were included. The indication for preterm delivery was classified as preterm labor (PTL), preterm pre-labor rupture of membranes (PPROM), or maternal/fetal indication. Exclusion criteria included multifetal gestations, prior course of AS or no anticipation of delivery in the next 7 days. Adjusted odds ratios with 95% confidence intervals were calculated for neonatal outcomes.

Results: The sample included 199 women in the AS group and 123 women in the non-AS group. Of those in the AS and non-AS groups, 92 and 61 had GDMA1; 107 and 62 had GDMA2. The indication for admission was PTL (22.1%, 26.8%), PPROM (21.6%, 35.8%) and maternal/fetal indication (56.3%, 37.4%) in the AS and non-AS groups respectively. In the AS group, 40% received one dose of steroids and 60% received two doses. After adjusting for gestational age at birth and birth weight, there were no significant differences in hypoglycemia (0.87 [0.53-1.43]) and NICU admission (1.03 [0.62-1.70]). Respiratory distress syndrome was lower in the AS group (0.50 [0.27-0.95]) but there was no difference in the composite respiratory score (0.93 [0.57-1.54]).

Conclusion: Administration of late preterm AS to women with GDM does not increase the risk of hypoglycemia or NICU admission. AS reduce the risk of respiratory distress syndrome but not other respiratory or neonatal morbidity.