Maternal antenatal corticosteroid administration prior to elective caesarean section (ECS) at < 39.0 weeks gestation reduces neonatal respiratory morbidity. Steroid therapy results in ‘difficult to manage’ hyperglycaemia in women with DIP, which can increase maternal and/or fetal risk. We have assessed whether neonates from pregnancies requiring ECS, complicated by DIP, between 37.0-38.9 weeks gestation, are at increased risk of respiratory distress (RDS).
A literature review revealed insufficient evidence that antenatal corticosteroid therapy in women with diabetes was safe and effective. Obstetrics, paediatrics and endocrinology discussed this and agreed that women with DIP would not receive steroids after 36.6 weeks gestation over a 12-month period commencing on the 1st May 2017.
Clinical records provided a list of all women who underwent ECS between 1st May 2016 – 31st August 2016 (period 1) and 1st May 2017 – 31st August 2017 (period 2). All ECS occurring at ≤ 36.6 weeks gestation and ≥ 39 weeks gestation were excluded. A retrospective manual audit of these files was undertaken. The full audit is nearing completion: initial data are shown here.
Thirty-four women (15 DIP) underwent an ECS having received antenatal steroids in period 1. Four (26.7%) babies of DIP mothers were admitted to the SCN with RDS and 2 (13.3%) with hypoglycaemia. In comparison, during period 2, 52 women underwent an ECS (17 DIP). Only 2 (11.8%) babies of DIP mothers were admitted to the SCN with RDS and 2 babies (11.8%) with hypoglycaemia.
Early results suggest that women with DIP undergoing ECS from 37.0-38.6 weeks gestation without prior steroid therapy are not likely to have a greater risk of RDS. Full results will soon be available.