Antenatal corticosteroids administered prior to preterm birth before 34 weeks are highly effective in preventing neonatal mortality, respiratory distress syndrome and reducing the risk of intraventricular haemorrhage. A single course of antenatal corticosteroids prior to preterm birth has now become a standard, prophylactic treatment against respiratory distress syndrome. Recently the Antenatal Late Preterm Steroids (ALPS) trial demonstrated benefit in gestations from 34 to 37 weeks and this practice has been recommended in clinical guidelines by ACOG.
Diabetes mellitus in pregnancy, both pre-gestational and gestational, is increasingly common, and late preterm birth among these women is more common than in the general population. In women with diabetes, however, corticosteroid administration is not without risk for the mother and neonate. There is a lack of good quality evidence for administration of corticosteroids in women with diabetes especially in the late preterm and early term gestations. Where evidence is lacking an individualised decision regarding the administration of corticosteroids considering both benefits and harms is appropriate.
This talk will review the evidence for antenatal corticosteroid administration at different gestations of pregnancy including in women with pre-existing and gestational diabetes and identify areas where further research is required.