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