Abstract This study aimed to review the biologic mechanisms, clinical evidence, and therapeutic considerations surrounding antenatal corticosteroid (ACS) use in preterm pregnancies complicated by gestational and pregestational diabetes, with a particular focus on the late preterm period and associated neonatal outcomes. Narrative review of randomized trials, observational studies, and mechanistic investigations evaluating fetal lung development, ACS exposure, and neonatal respiratory outcomes in diabetic pregnancies. Diabetes disrupts fetal lung maturation through fetal hyperinsulinemia and delayed surfactant synthesis, resulting in increased neonatal respiratory morbidity extending into the late preterm period. While late preterm ACS reduce the need for neonatal respiratory support, including transient tachypnea of the newborn, in non-diabetic populations, pregestational diabetic pregnancies were excluded from pivotal trials. Emerging observational and randomized data suggest similar respiratory benefit in diabetic pregnancies, though accompanied by predictable metabolic effects, including maternal hyperglycemia, which are modifiable with anticipatory clinical management. Available biologic and clinical evidence supports consideration of late preterm ACS in pregnancies complicated by diabetes when delivery is anticipated within 7 days. With proactive metabolic management, respiratory benefits can be achieved while minimizing maternal and neonatal risks.
Higgs et al. (Fri,) studied this question.