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.