Results
Between the period of 01 January 2011 and 31 December 2019, 306 consecutive patients met the inclusion criteria. Of these, 65 (21.2%) women were exposed to ACS prior to elective caesarean section and 241 (78.8%) women were not. From 2011 to 2015, there was a striking increase in the proportion of women with pre-gestational diabetes who received ACS prior to elective caesarean delivery (0/20 women received ACS in 2011 and 14/31 (45%) received ACS in 2015). In subsequent years, the proportion of women with pre-gestational diabetes who received ACS declined from 2015 to 2019 (4/46; 9%) (Figure 1).
Maternal age, parity, earliest HbA1C and latest HbA1C did not differ between the two groups (Table 1). Gestational age at the time of birth was lower in women who received ACS prior to elective caesarean section (mean (standard deviation): 37+1 (0.6 days)) compared to women who did not (mean (SD): 37+5 (0.7 days)). Similarly, birthweight was lower in women who received ACS (mean (SD): 3535 (706) grams) compared to those who did not (mean (SD): 3671 (703) grams). There were no differences in the proportion of infants requiring respiratory support amongst neonates who were exposed to ACS compared to neonates who were not exposed to ACS, however, there was a non-statistically significant reduction in the requirement for nursery admission and respiratory support in ACS exposed infants born prior to 38+0weeks compared to those who were not exposed. Similarly, neonates exposed to ACS who were born prior to 37+0 weeks were less likely to require parenteral treatment for neonatal hypoglycaemia, however those born after 37+0 weeks were more likely to require parenteral treatment for neonatal hypoglycaemia, but these findings were not statistically significant. Potential sepsis requiring IV antibiotics was also not statistically significantly associated with ACS exposure, however a non-significant reduction in the proportion of infants with potential sepsis requiring IV antibiotics was seen amongst infants born prior to 38+0 weeks, while a non-statistically significant increase was seen in those born after 38+0 weeks (Table 2).