Question 57

Maternal diabetes is not an absolute contraindication to antenatal corticosteroid treatment when there is a significant risk of preterm birth. At 32+1 weeks, this woman is within the gestational range in which neonatal benefit is expected. Corticosteroids can, however, cause clinically important maternal hyperglycaemia, and women with diabetes may therefore require intensified glucose monitoring and additional insulin according to an established protocol. The steroid dose should not simply be reduced, and an unvalidated alternative oral regimen should not be substituted. Similarly, indicated birth should not be postponed solely because of corticosteroid-associated glucose disturbance. Neonatal hypoglycaemia is also an important consideration after corticosteroid exposure, particularly at later gestations and in pregnancies complicated by diabetes, but this does not justify withholding an otherwise indicated course at 32 weeks. The appropriate strategy is therefore to provide antenatal corticosteroids while actively anticipating and managing the maternal glycaemic consequences.

A) Diabetes is not an absolute contraindication to antenatal corticosteroids.

C) Corticosteroids can significantly increase maternal glucose and require intensified surveillance.

D) Oral corticosteroid administration is not the recommended substitute for the standard intramuscular regimen.

E) The corticosteroid dose should not be halved because of diabetes.

F) Required birth should not be delayed solely because of corticosteroid-associated glucose disturbance.

G) Fetal lung maturity testing is not required before treatment.

H) Neonatal hypoglycaemia can be anticipated, assessed and managed after birth.

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.