Question 45

Maternal diabetes is not an absolute contraindication to antenatal corticosteroid administration when preterm birth is anticipated. At 32+5 weeks with established preterm labour, this woman has a standard indication for treatment. Corticosteroids can produce a clinically important rise in maternal blood glucose, so women with diabetes require additional surveillance and appropriate adjustment of insulin according to local diabetic pregnancy protocols. The potential neonatal benefit of antenatal corticosteroids should not be lost solely because the mother has diabetes. Reducing the corticosteroid dose is not recommended as a strategy for preventing hyperglycaemia, and treatment should not be deferred while waiting for glucose to remain normal without insulin. Intramuscular corticosteroid regimens are recommended rather than substituting oral treatment. The appropriate approach is therefore to administer the indicated antenatal corticosteroid course while anticipating and actively managing the maternal glycaemic effect through close blood glucose monitoring and additional insulin when required.

A) Diabetes is not an absolute contraindication to antenatal corticosteroids when preterm birth is anticipated.

C) The corticosteroid dose should not be arbitrarily reduced because of maternal diabetes.

D) Treatment should not be deferred until glucose is normal without insulin; hyperglycaemia should instead be actively managed.

E) The recommended antenatal corticosteroid regimens are administered intramuscularly rather than by substituting oral therapy.

Stock SJ, Thomson AJ, Papworth S, on behalf of the Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG. 2022;129:e35–e60. RCOG Green-top Guideline No. 74. doi:10.1111/1471-0528.17027.