INTRODUCTION
The antenatal administration of high dose corticosteroids for neonates
born before 34 weeks is a key priority in maternity and neonatal
practice 1-4. Clear benefits in perinatal death and
serious morbidity are reported 2.
Most exposed neonates, however, are born after 34 weeks; many at term5, as the prediction of preterm labour is so imprecise6. Further, the upper gestation at which antenatal
corticosteroids (ACS) are commonly given has increased. Several
guidelines 1-4 and trials recommend ACS after 34 weeks7-9, and even prior to caesarean section at early term
gestation 10-12 due to the latter’s association with
neonatal respiratory complications 13.
These policies are controversial and not universal 4.
As birth at later gestation is more common and the consequences of
prematurity less severe, any capacity for corticosteroid-related harm is
correspondingly greater. ACS appear to increase the risk of neonatal
hypoglycaemia 8, 14. Where severe, this is a common
cause of term neonatal unit admission 15 and has been
associated with long term neurological deficit 16. As
most corticosteroid trials focus on participant outcomes before term8 or have not assessed hypoglycaemia10, 11, good
data in term neonates is lacking.
The aim of this study was to assess the association between antenatal
corticosteroid administration and severe hypoglycaemia in neonates born
at term. The analysis addresses two groups: 1) those exposed before 34
weeks because of a perceived risk of severe preterm birth but
subsequently deliver at term; and 2) those exposed after 34 weeks
because of anticipated late preterm or early term birth.