Objective: The objective of this study was to evaluate the associations between antenatal corticosteroid (ACS) administration and neonatal outcomes in women with pre-gestational diabetes (PGDM) when administered prior to elective caesarean section (CS) after 36 weeks gestation. Design: Retrospective observational study. Setting: This study took place in two academic hospitals in Melbourne, Australia. Sample: All women with PGDM who gave birth by elective CS between 36+0 and 38+6 weeks’ gestation. Main Outcome Measures: Neonatal outcomes (neonatal respiratory distress requiring respiratory support for more than 60 minutes, admission to neonatal nursery, neonatal hypoglycaemia requiring parenteral treatment and neonatal sepsis) for exposed participants (those who received ACS within 7 days prior to birth) were compared to outcomes for nonexposed participants. Results: Of the 306 women identified, 65 (21.2%) were exposed to ACS and 241 (78.8%) were not. Although not statistically significant, infants born prior to 38+0 weeks who were exposed to ACS were less likely to require respiratory support or neonatal nursery admission compared to those who were not exposed, however, exposed infants born after 37+0 weeks were more likely to require parenteral treatment for neonatal hypoglycaemia. Conclusion: This study demonstrated potential clinically relevant beneficial and harmful effects of ACS in neonates of women with PGDM who are born by elective CS. While it is plausible that ACS could reduce neonatal respiratory morbidity in this population, further prospective studies evaluating the benefits and harms are required before recommending this practice.

Pregnant individuals are known to be at increased risk of worse outcomes from COVID-19 infection. Recent data suggests that they are also more likely to exhibit milder symptoms and have higher rates of asymptomatic infection. The health impacts of milder disease are less well-described but may include adverse perinatal outcomes. Serosurveillance can help describe accurately background rates of seropositivity in populations with high rates of asymptomatic infection. The seroprevalence of SARS-CoV-2 infection prior to vaccine availability was assessed in two large maternity centres. Of 437 pregnant individuals, seven were positive on initial screening, with one false positive identified on subsequent confirmatory testing. An overall seropositivity rate of 1.4% was found. No adverse pregnancy outcomes were identified. Confirmatory testing was performed with four commercial antibody-based assays and an in-house microneutralisation assay. Wantai SARS-CoV-2 receptor-binding-domain total antibody performed best, similar to previous reports. Serological surveillance can estimate infection rates not captured by acute PCR testing, and may assist with contact tracing, estimation of immunity rates and inform public health policy in at-risk groups. Evaluation of serological assays should be integrated into serosurveillance initiatives.

Objective The My Baby’s Movements (MBM) trial aimed to evaluate the impact on stillbirth rates of a multifaceted awareness package (MBM intervention). Design Stepped-wedge cluster-randomised controlled trial. Setting Twenty-seven maternity hospitals in Australia and New Zealand. Population Women with a singleton pregnancy without major fetal anomaly ≥28 weeks’ gestation from August 2016-May 2019. Methods The MBM intervention was implemented at randomly assigned time points with sequential introduction into 8 clusters of 3-5 hospitals at four-monthly intervals. The stillbirth rate was compared in the control and intervention periods. Generalised linear mixed models controlled for calendar time, clustering, and hospital effects. Outcome Measures Stillbirth at ≥28 weeks’ gestation. Results There were 304,853 births with 290,219 meeting inclusion criteria: 150,079 in control and 140,140 in intervention periods. The stillbirth rate during the intervention was lower than the control period (2.2/1000 births versus 2.4, odds ratio [OR] 0.91, 95% Confidence Intervals [CI] 0.78-1.06, p=0.22). The decrease was larger across calendar time with 2.7/1000 in the first 18 months versus 2.0/1000 in the last 18 months (OR 0.74; 95% CI 0.63-0.86; p≤0.01). Following adjustment, stillbirth rates between the control and intervention periods were not significantly different: (aOR 1.18, 95% CI 0.93-1.50; p=0.18). No increase in secondary outcomes, including obstetric intervention or adverse neonatal outcome, was evident. Conclusion The MBM intervention did not reduce stillbirths beyond the downward trend over time, suggesting hospitals may have implemented best practice in DFM management outside their randomisation schedule. The role of interventions for raising awareness of DFM remains unclear