(1018) Late preterm antenatal steroids in women with pregestational diabetes mellitus

Pregnant people with pregestational diabetes mellitus (PGDM) were excluded from the ALPS study due to concern for worsening hypoglycemia in neonates exposed to antenatal steroids (AS). However, AS may improve neonatal respiratory outcomes, which are compromised in neonates of diabetic mothers. The objective of this study was to examine the rate of neonatal hypoglycemia, NICU admission and respiratory morbidity in neonates exposed to late preterm AS compared to 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 Type 1 or 2 diabetes (T1DM, T2DM) 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 for delivery in the next 7 days. Adjusted odds ratios with 95% confidence intervals were calculated for neonatal outcomes.

Results: The sample included 65 women in the AS group and 58 women in the non-AS group. Of mothers in the AS and non-AS groups, 12 and 14 had T1DM and 53 and 44 had T2DM, respectively. The indication for admission was PTL (12.3%, 10.3%), PPROM (12.3%, 22.4%) and maternal/fetal indication (75.4%, 67.2%) in the AS and non-AS groups, respectively. In the AS group, 38% received one dose of steroids and 61% received two doses. After adjusting for gestational age at birth and birth weight, there were no significant differences in hypoglycemia (1.54 [0.71-3.41]) and NICU admission (0.81 [0.31-2.06]). There was a trend toward decreased composite respiratory score in the AS group (0.456 [0.19-1.05]) as well as a significant reduction in supplemental oxygen and need for resuscitation.

Conclusion: Administration of late preterm AS to women with PGDM does not increase the risk of hypoglycemia or NICU admission in our retrospective cohort. Neonatal respiratory morbidity with AS may be decreased.