Conclusion
This study did not demonstrate a beneficial effect on respiratory
morbidity in 306 consecutive infants delivered via caesarean section
between 36+0 and 38+6 to mothers
with pre-gestational diabetes. The practice of administering ACS prior
to elective caesarean section in women with pre-gestational diabetes,
has varied significantly over the past 10 years with an increasing
proportion of women receiving ACS up to 2015, with a steady decline
until less than 10% of women with pre-gestational diabetes receiving
ACS prior to elective caesarean section in 2019. Practice has
significantly varied regarding ACS administration, despite the lack of
robust evidence for benefit or harm of this intervention. The effects of
maternal hyperglycaemia and the potential increase in neonatal
hypoglycaemia in neonates that were exposed to ACS needs further
investigation in prospective studies. However, beneficial effects on
neonatal respiratory morbidity and neonatal nursery admission have
potential health and economic benefits which would make the practice of
ACS administration a cost-effective intervention. Further research
investigating the potential short and long term benefits and harms of
administering ACS during the late pre-term and term periods in women
with pre-gestational and gestational diabetes who are undergoing birth
by planned elective caesarean delivery is urgently needed.