Neonatal Respiratory Distress
In this study, there were no statistically significant differences in
the rates of neonatal respiratory morbidity requiring respiratory
support. Respiratory distress was defined in this study as neonates
requiring respiratory support for >60 minutes to exclude
neonates who simply needed some respiratory support during transition
and to include those neonates requiring significant respiratory support.
Previous studies have reported that infants of women with diabetes are
at greater risk of respiratory distress than gestational age matched
controls.11 This is due to delay in maturation of
surfactant producing Type II alveolar cells in the infants of women with
diabetes which is thought to be secondary to maternal hyperglycemia
leading to fetal hyperglycemia and fetal
hyperinsulinemia.11, 34 Despite the extensive body of
literature supporting the beneficial effects of ACS in preterm infants,
the value of ACS for preventing respiratory distress in infants of women
with diabetes has not been established in the preterm or term period as
too few women with diabetes have been included in trials assessing
ACS.1, 9, 13. There are no studies investigating the
role of antenatal corticosteroid use in women with pre-gestational
diabetes.1,9 The limited data on the role of ACS in
women with gestational diabetes comes from a single randomized trial
which included 306 women with gestational diabetes who did not require
pharmacological treatment.16 However, this subgroup
represented approximately 11% of the entire cohort recruited to this
study and was underpowered to draw significant conclusions regarding the
benefits or harms of ACS in women with gestational
diabetes.16